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RBPR-06-2023-44701.TIF
A Ise g-ot •x 3 - q 100 „�srat„4,0 ROY COOPER•Governor 4- ,'. 3 oTs° NC DEPARTMENT OF KODY H. KINSLEY• Secretary W- - -I - pll HEALTH AND ��" HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health .� • .;z MARK T. BENTON •Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR AUTHORIZED ON-SITE WASTEWATER EVALUATOR PERMIT OPTION FOR NON-ENGINEERED SYSTEMS See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the AOWE in accordance with G.S.130A-336.2 LHD USE ONLY: Initial submittal of this NOI received: by Date Initials PART 1:Notice of Intent to Construct(NOI)-Please check all that apply ®Single System or ❑Multiple Systems AND ® New [' Expansion ❑ Relocation of all or part of the Existing System ❑ Relocation of Repair Area ❑ Repair—LHD Permit Number ❑ Repair—EOP/LSS COVID 19/AOWE Permit Number 1. Facility Owner's name: (Owner,Company Name, Utility, Partnership, Individual,etc.): Century Complete Mailing address: 9325 Center Lake Dr., Suite 160 City: Charlotte State: NC Zip: 28216 Telephone number: 704-488-1100 E-mail Address: katie.dyess@centurycommunities.com 2. Authorized On-Site Wastewater Evaluator(AOWE) name: Larry Thompson LSS License number: 1208 AOWE Certification number: 10016E Mailing address: PO Box 541 City: Midland State: NC Zip: 28107 Telephone number: 704-301-4881 E-mail Address: larry@thompsonenv.com 3. Licensed Geologist(LG)(if applicable) name: N/A License Number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 4. Proof of Errors and Omissions or other appropriate liability insurance for the following persons is attached that includes the name of the insurer, name of the insured and the effective dates of coverage: ❑� AOWE ❑ LG 5. Property location(physical address,tax parcel identification number or subdivision lot, block number of the property to be permitted): 1274 Elgin Drive, Conover, NC 28613 (PIN: 373411752004) County Name: Catawba 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 AOWE Common Form LHD Reference: 6. Type of facility: Q Place of residence No. Bedrooms: 4 No.Occupants:8 ❑ Place of business Basis for flow calculation: ❑ Place of public assembly Basis for flow calculation: 7. Factors that would affect the wastewater load: Proposal is for domestic wastewater strength only. 8. Type and location of proposed wastewater system: Gravity-flow accepted system located behind the residence. System classification Type Illg. 9. Design wastewater flow: 480 gpd Design wastewater strength: domestic ❑high strength ❑industrial process(For high strength and industrial process wastewater,a Professional Engineer licensed in accordance with G.S.89C shall design the on-site wastewater system.) 10. A plat as defined in G.S. 130A-334(7a)is attached: ❑Yes 4 No A site plan as defined in G.S.130A-334(13a)is attached: 0 Yes ❑ No 11. Location of proposed or existing wells(drinking water,irrigation,geothermal,groundwater monitoring, sampling,etc.)and any potable and non-potable water conveyance lines is indicated on attached plans and complies with 15A NCAC 18A.1950: ❑■ Yes ❑No This is a saprolite system. ❑Yes ❑� No 12. Evaluation(s)of soil conditions and site features in accordance with G.S. 130A-335(a1)signed and sealed by a LSS is attached: ❑■ Yes ❑ No 13. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes ❑■ NA 14. Proposed landscape,site,drainage,or soil modifications are attached: ❑Yes El NA Attestation by AOWE pursuant to G.S. 130A-336.2 Larry Thompson hereby attest that the information required to be included with Authorized On-Site Wastewater Evaluator(Print Name) this Notice of Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall meet applicable federal,State,and local laws,regulations,rules and ordinances,and that the proposed system does not require a Professional Engineer,licensed in accordance with G.S.89C,and in accordance with 15A NCAC 18A.1938 activities determined to be engineering as determined by the North Carolina Board of Examiners for E s a urveyors. f , 06-20-23 Signature of hor'zpi r lte Wastewater aluator Date twper self-submittal of NO!: hereby submit this NOI prepared by Print Name of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Date DHHS/EHS/OSWP-AOWE COMMON FORM Updated April2022 Page 2 of 6 AOWE Common Form LHD Reference: NOTES: LIABILITY: The Deportment,the Department's authorized agents,or local health departments shall have no liability for wastewater systems designed,constructed,and Installed pursuant to an AOWE Permit Option[G.S.130A-336.2(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. DHHS/EHS/OSWP—AOWE COMMON FORM Updated April2022 Page 3 of 6 AOWE 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 the notice of intent to construct required pursuant to subsection(b)of this section is complete within five business days after receiving the notice of intent to construct.A determination of completeness means that the notice of intent to construct includes all of the required components.If the local health department determines that the notice of intent to construct is incomplete,the local health department shall notify the owner and list the information needed to complete the notice.The owner may then submit additional information to the local health department to cure the deficiencies in the initial notice.The local health department shall make a final determination as to whether the notice of intent to construct is complete within five business days after the department receives the additional information.If the local health department foils to act within any time period set out in this subsection,the owner may treat the failure to act as a determination of completeness. The owner shall be able to apply for the building permit for the project upon the decision of completeness of the notice of intent by the local health department or if the local health department fails to act within the five business day time period." The review for completeness of this Notice of Intent was conducted in accordance with G.S. 130A-336.2(c). This NOI is determined to be: ❑ INCOMPLETE(If box is checked, Information in this section is required.) Based upon review of information submitted in Part 1,the following items are missing: Copies of this form listing missing items were sent to the AOWE and the Owner on Date via with directions to re-submit missing items using Page 5 of this form. Email,FAX,LISPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date ❑ 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 AOWE 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,LISPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date DHHS/EHS/05WP—AOWE COMMON FORM Updated April2022 Page 4 of 6 AOWE Common Form LHD Reference: Re-submittal of NOI with missing items included This Section is for use by owner to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the AOWE. LHD USE ONLY: This NOI resubmittal received: by Date Initials Item#from initial NOI Resubmittal description Attestation by AOWE certified in North Carolina pursuant to G.S. 130A-336.2 I, hereby attest that the information required to be included with Authorized On-Site Wastewater Evaluator(Print Nome) this Notice of Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall meet applicable federal,State,and local laws, regulations, rules, and ordinances. Signature of Authorized On-Site Wastewater Evaluator Date The section below is for Local Health Deportment use after submittal of items noted as missing above. LHD Follow-up Completeness Review of Notice of Intent to Construct This follow-up review for completeness of this Notice and Intent was conducted in accordance with G.S. 130A- 336.2(c). This NOI is determined to be: ❑ INCOMPLETE Based upon review of information submitted in the RESUBMITTAL above,this Notice of Intent remains INCOMPETE because the following items from Part 1 of this form remain missing: Copies of this signed form were sent to the AOWE 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 AOWE and the Owner on via Dote Email,FAX,LISPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Date Email,FAX,LISPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHHS/ENS/05WP—AOWE COMMON FORM Updated April 2022 Page 5 of 6 AOWE Common Form LHD Reference: PART 3: Authorization to Operate(ATO) Except for dote received,the Section below Is to be completed by the Owner. LHD USE ONLY: Initial submittal of request for ATO received: by Date Initials Date of Post-construction Conference: T The following items are included in this submittal for an Authorization to Operate under an AOWE permit: 1. Signed and sealed copy of the AOWE's report that includes the information in G.S. 130A-336.2(k) ❑Yes L 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 AOWE ❑Yes ❑ No 5. On-site Wastewater Contractor name: License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 6. Proof of Errors and Omissions or other appropriate liability insurance for the On-site Wastewater Contractor is attached and includes the name of the insurer, name of the insured,and the effective dates of coverage. ❑Yes ❑ No Attestation by the Owner for Authorization to Operate I, hereby attest that all items indicated above have been provided to the Print name of Owner County LHD and the system shall meet applicable federal,State,and local laws, regulations,rules,and ordinances. Signature of Owner Date This section for 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 AOWE permit: Copies of this signed form were sent to the AOWE 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 El COMPLETE Based upon review of information submitted in the Section above,this Authorization to Operate is hereby issued in accordance with G.S. 130A-336.2(m). A copy of this complete NOI/ATO with tracking information was sent to the State on via Date Email,FAX,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 o residence,place of business or place of public assembly pursuant to G.S.130A-339. DI-IHS/EHS/OSWP—AOWE COMMON FORM Updated April 2022 Page 6 of 6 AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 1-13 PHASE PARCEL ID: STREET ADDRESS: Spring Farms Subdivision Conover, NC 28613 Please print: Property Owner: Century Complete Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize Larry Thompson, LSS of Thompson Environmental Consulting, Inc. (Contractor/ Agent) (Name of consulting firm) to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or certification and any and all standard and special conditions attached. Property Owner's Address (if different than property above): 9325 Center Lake Dr., Suite 160, Charlotte, NC 28216 Telephone: 704-488-1100 We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. The LSS/LG evaluation(s) attached to this application is to be used to issue an Improvement Permit in accordance with G.S. 130A-335(a2) and (a3). The plans or evaluations attached to this application are to be used to issue a Construction Authorization in accordance with G.S. 130A-335(a2), (a5) and (a6). Owner Signatur�e: Owner Signature: at Date: Apr 19,2023 Date: DATE(MMfODlYYYY) QQQiRR[[[ CERTIFICATE OF LIABILITY INSURANCE 9/7/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CONTACT David Vaughan Higginbotham Insurance Agency, Inc. PHONE FAX 500 W. 13th Street (A/C No.Ext):9187797880 _ (AM,Not:817-882-9284 EML Fort Worth TX 76102 ADDRess: dlvjr@higginbotham.net INSURER(S)AFFORDING COVERAGE NAIC# License#:2081754 INSURER A:Mid-Continent Casualty Company 23418 INSURED THOMENV-01 INSURER B:Hartford Underwriters Insurance Company 30104 Thompson Environmental Consulting, Inc. PO Box 541 INSURER C: Midland NC 28107-0541 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1600075032 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP)_( LIMITS LTRINSD WVD POLICY NUMBER (MM/DD/YYYYMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY 04-GL-0010861372 9/25/2022 9/25/2023 EACH OCCURRENCE $1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISESOa( ENTED occu occurrence) $100,000 X Professional MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY PELT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ - AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 38WECNW6175 10/17/2022 10/17/2023 X AND EMPLOYERS'LIABILITY STATUTE OTH- ER ANYPROPRIETORJPARTNER/EXECUTIVE YNN N!A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Residential Subsurface Wastewater Treatment and Disposal System AOWE Repair Permit for Lot 2 - Spring Farms 1274 Elgin Drive Conover, NC 28613 Tax Parcel Number: 373411752004 June 20, 2023 Prepared for: sa1t sc./ Century Complete ( /14, , 9325 Center Lake Dr., Suite 160 � 704-488-1100 czar ' Prepared by: y rry Larry Thompson, REHS, LSS ; • 4%* .. .. Thompson Environmental Consulting, Inc. i : c . PO Box 541 • ' c+Vtic Lion . ' ` Midland, NC 28107-0541 = * k Phone: 704-301-4881 ?� 10016E larry@thompsonenv.com s 1 �• u • ./A f' .I. �. Lot 2-Spring Farms Project Specifics Century Complete has contracted with Thompson Environmental Consulting, Inc. (TEC) to prepare an AOWE septic permit package for a new 4-bedroom single-family residence to be located at Lot 2 - Spring Farms, 1274 Elgin Drive, Conover, North Carolina (Catawba County Parcel Number: 373411752004). Based upon a soil and site evaluation performed by TEC, it was determined that a sufficient amount of"Provisionally Suitable" Group IV soils are available for the installation and repair, of a Gravity Flow Accepted System for a 480 gallon-per-day residence at a 0.3 GPD/sq/ft long- term acceptance rate (LTAR). The property will be served public water. The LSS/LG evaluation(s) attached to this application is to be used to issue an Improvement Permit in accordance with G.S. 130A-335(a2) and (a3), and the plans or evaluations attached to this application are to be used to issue a Construction Authorization in accordance with G.S. 130A-335(a2), (a5) and (a6). Location From Hickory, take Springs Street to Hall Street. Turn left onto Hall Street, and left onto Elgin Drive. Lot is located on the corner of Hall Street and Elgin Drive. References Laws and Rules for Sewage Treatment and Disposal Systems, 15A NCAC 18A, Section .1900, Department of Environment and Natural Resources, Division of Environmental Health, On-Site Wastewater Section, April 1, 2017. Accepted Wastewater System No. AWWS 2005-02-R6; North Carolina Department of Environment and Natural Resources, Division of Environmental Health, On-Site Wastewater Section, August 21, 2015. Primary Investigator's Credentials NC Registered Sanitarian No. 1208 NC Licensed Soil Scientist No. 1287 NC Authorized Onsite Wastewater Evaluator No. 10016E SC Certified Professional Soil Classifier No. 111 NC Subsurface Septic System Operator No. 22199 NC Grade IV Wastewater System Installer No. 1762 NC Certified Wastewater System Inspector No. 17621 Lot 2-Spring Farms Plans and Specifications A. Septic Tank 1. The septic tank shall be State approved (Section .1953 of 15A NCAC 18A), watertight, structurally sound, and 1,000 gallons in capacity. 2. The septic tank shall be fitted with an approved effluent filter. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tanks have had time to properly cure and are free of cracks or other structural deficiencies. B. Pipe, Fittings and Supply Line 1. All discharge piping, connectors, and supply lines should be made of SCH 40 PVC and fitted with pressure-rated couplings. 2. All joints must be properly "welded" utilizing the appropriate PVC cement for each application. C. Distribution Method 1. Individual drainlines shall be evenly fed via a distribution box. 2. Distribution box shall be water tested for equal flow at the time of the final inspection. D. Drainfield Installation 1. The drainfield has been previously laid out on-site utilizing metal stemmed flags. The property owner/builder should mark this area and isolate it as much as possible from construction traffic 2. Under no circumstances shall any construction take place within the drainfield area while the soil is in a wet condition. 3. The specified system is an accepted wastewater system, specifically the Infiltrator Quick 4 chamber system or any other system with a state-approved 25% reduction in required drainline length. 4. The drainfield consists of four, (4) lateral trenches 3-foot wide by 100-ft long. Total trench length is 400 feet. 5. The maximum trench depth for this system shall be 12 inches. 6. The laterals are to be installed on contour with the land, keeping the individual trench bottoms level from beginning to end. 7. The trenches should be left open for the final inspection by the health department. E. Final Landscaping 1. The final soil cover over the drainfield shall be a minimum of 6 inches deep. Additional cover will be required to achieve 6 inches. 2. The drainfield shall be shaped to shed rainwater and be free from low spots. 3. The drainfield area should be planted with grass as soon as possible to prevent erosion. The soil should be properly tilled, limed (if necessary) and fertilized prior to planting. Lot 2-Spring Farms After applying grass seed, the area should be heavily mulched with straw or other suitable material. Maintenance F. In General 1. The homeowner must maintain the drainfield area through periodic mowing. The drainfield must not be allowed to become overgrown. 2. The septic tank should be pumped every 4 years or when the solids within the septic tank reach an elevation equivalent to 25 percent of the tank's volume. In some situations, the tanks may need to be pumped more frequently. If using a garbage disposal, it is recommended that the homeowner has the septic and pump tanks cleaned out annually. 3. When cleaning the effluent filter, the filter should be removed, and the accumulated debris will be washed back into the septic tank—not onto the lawn. 4. Any damp areas, leakages, or malfunctions in the drainfield area should be addressed immediately. 5. Divert gutter downspouts and surface water runoff away from the septic and pump tanks. Design Specifics Daily Design Flow: 480 GPD—4 bedroom house Septic Tank Size: 1,000 Gallons (minimum) Effluent Loading Rate: 0.3 GPD per sq. ft. Drainfield Type: Accepted (25%Reduction) Distribution Method: Distribution Box Number of Drainlines (4) 3-ft Wide x 100-ft Long Total Trench Length: 400 Linear Feet Maximum Trench Depth: 12 Inches Required Soil Cover: 6 Inches Repair Option Effluent Loading Rate: 0.3 GPD per sq. ft. Drainfield Type: Accepted 25% Reduction Required Linear Footage: 400 Linear Feet Lot 2-Spring Farms Available Linear Footage: 433 Linear Feet Maximum Trench Depth: 20 Inches Required Soil Cover: 6 Inches Sporq 1 1_,aa _ _________,,., /6,1 ,, 1 -2.-.. Lio( . 38, , w}P 419- \ ''‘ WS 0 - tt;''',i r 004,`r ryryqO. e 'I c;f0 la ma' �� 1goo' 1.)60x ' ' 1,"--7-674,,n hmu 12r* -- -.-.-'`---,.,_----.—------ -Li ,c7.,ci--C-:.------------. ba)(30,1,., e---tc...' ---f-cay.LL n d` 10' _.__ J 1 f ,33 Thompson Environmental Consulting,Inc. sieeee7I of� PO Box 541 PROPERTY ID/: 573' ?( ` Ogg Midland,NC 28107 COUNTY: Cdra aJ)GY SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNER: ( w [1;t A.A. L0 Q' ) � I 3 ADDRESS: O DATE EVALUATED:—�O L3_ PROPOSED FACILITY: l� /�A IV\ PROPOSED DESIGN FLOW(.1949): 11 PROPERTY SJ7F: rt LOCATION OF SITE: lb 1 a-1`A g4 gill r7 t'✓ PROPERTY RECORDED: WATER SUPPLY: 0 Private El-Public 0 Well ❑Spring U Other EVALUATION METHOD: tu$er Boring 0 Pit 0 Cut TYPE OF WASTEWATER I-Ysewage 0 Industrial Process ❑Mixed P R SOIL MORPHOLOGY OTHER • F (.1941) PROFILE FACTORS 1 .1940 E LANDSCAPE HORIZON — POSITION/ DEPTH .1942 PROFILE. • SLOPE% (M .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR <AR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ (9_ qg _ 51,,,t fisss.r L 1 L( . , i,s../- - ._ cs)5 L �_i4 2 L -.- l , . L! 4 / _ PTI DESCRION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.I946): T/ D SOIL SC � SITE CLASSIFICATION(.1948): •revs'.al : (_,.4 _. 0,, Available Space(.1945) PS PS 4. ,.0,...4.P0 ti 'i'J'� EVALUATED BY: ,,,.1L l�4!44i SystemType(s) Accepted Accepted OTI-ZER(S)PRESENT: BM r E} )r 1t- Site LTAR 0.3 0.3 L.Thom.son, LSS ' . 4-;'._>f. i COMMENTS: .,- dil. r,>t ii+►-44L.ic or, ' Updated February 2014 Ci%Cifati C • • 1/u1ck4M STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) • • _ __ 12" I IDo9®gym===I@ ®� _ r. • are Ewe eemac_ e a ma- • 34" SIDE VIEW SECTION VIEW MultiPort End Cap mom10-411 • I' 16" 12° \\ \ 34" SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (WxLxH) 34"x52"x12" Size (WxLxIt) 34"x16"x12" Effective Length 48" Invert Height 8"or 1.25" Invert Height 8" INFILTRATOR SYSTEMS.INC.STANDARD LIMITED WARRANTY (a)The structural integrity of each chamber,end plate,wedge and other accessory manufactured by Infiltrator("Units"),when Instated and operated in a IeachfiekI of an onste septic system in accordance with Inftretor's instructions,Is warranted to the original purchaser("Holder')against defective Atetalamt materiels and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units:prodded,however, Mat ifa septic permit ty not requireds, by applicable law.the or win writing at rl begin Head the date inhOl installationSaybr , the septicc system commend. I N FI LTRAT�R To exercise its warranty rights.Holder must notify Infiltrator in writlng at its Corporate Headquarters Old Saybrook,Connecticut within fifteen(15) days of the alleged defect.Infiltrator wAl supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's lability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES Wfal RESPECT a TO THE UNITS,INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. [jYu3TE M S I f J C (c)Thls Limited Warranty shall be void If any port of the chamber system is manufactured by anyone other than Infitratar. The Limited Warranty does rot extend to incidental,consequential,special or indirect damages.Infiltrates shall not be liable for penalties or liquidated damages,including loss of Environmental Onsite Wastewater Solutions"' production and profits,labor end materials.overhead costs,or other losses or expenses incurred by the Holder or any third patty.Specifically excluded front Limited Warranty coverage are damage to the Units due to ordinary wear and tear.alteration.accident.misuse.abuse or neglect of the Units:the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation Instructions;failure to maintain the 6 Business Park Road•P.O. Box 768 minimum ground covers set forth in the installation instructions;the placement of improper materials into the system containing the Units:failure of the Units or the septic system due to improper siting or improper sizing,excessive water usage.Improper grease disposal,or improper operation:a Old Saybrook, CT 06475 any erthrry event not caused by Infiltrator.This Limited Warranty shah be void If the Holder falls to comply with all of the terms set forth In this HintedWarr 860-577-7000• FAX 860-577-7001 Further,In no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units.or any third party resulting born installation or ship- O p o O-n rti 1-44 r�C went,or from any product liability claims of Holder or any third party.For this Limited Warranty to apply,the Units must be installed in accordance G L J V with all site conditions required by state and Peal codes:all other applicable laws;and Infiltrator s hstalletlon instruction. (d)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty apples to any party other than the origi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limed number of states and counties have afferent warranty require- ments.My purchaser of Units should contact infitrator's Corporate Headquarters in Old Saybrook.Cour mc.Ncut,prior to such purchase,to obtain a copy of the applicable warranty,and should carefully read that warranty prior to the purchase of lints. U.S.Patents:4.759,661;5,017,041;5,156,488;5,336,017:5,401,116;5,401,459;5,511,903;5.716,163;5,588,778:5.839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending. Infiltrator.Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc.Infiftrator is a registered trademark in France.Infiltrator Systems Inc. is a registered trademark in Mexico.Contour.Contour Swivel Connection,MicroLeaching.PolyTuff,SnapLock,ChamberSpacer,PosiLock,QulckCut.QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc.C 2003 Infiltrator Systems Inc.Printed in U.S.A. 0011203HP-0 Flood Hazard Area Certificate According to mopping prod.by the Federal*worry Monagemml Agway and 6 forte w,Rd Moen on the Weal flood Msura ke.tole tap(0nAMJ Pete)2754 Cat** / q c Pd Cwnly North Cwa'h&.linden vat&Solent*A 2007 Gm properly Morn tl nween Is not laca1M eIll,a.p,clor Oa*nomad one.the ropety 4'minty A I f. web n one Wok*W'lone N-ether onset'Arta orlon*.to be outside / 1 8 sienna �1. No 0.2X nnuat roam Moderate:woos cote*Mum condition.IX eonutl drone Boodsht't. }yotershed Cartlncate: ' To ID.best of my kn.Ne.*.Nh plot does not he wank a rv,a, y H SulF e ffets f•r*.*scree ay No North Comte°*Oka of Weft Ado (Tg;n M En*on.ntol N0,a0emw,t as appear an the.btershed Protection Mop al Celoaoe Caunf4 NOV,Cwau& d /4'' Envfonmental*OM Approval of Subdlvlslon Plot • Env rend plat and lob horn t e been opprovei by ton ` �I Mk final plat Heaand l s show at ton Catawba County Deportment of Public Hoe.. ,L d pi Vicinity MopNTS ) • (oo000��,°lth Sop,aka,or Design« g �spse, p d / it,' Notice •Prapeny 07 001 fo any aoaennts and skint aI«y an wont • F �t and df NNOY e°twn•nU and rgnU el n g13td p/ ,Q r.Ao Tom® •IDh winery M wbNet to any bets that may be diaaard by a 5� 7 b MI and amen*lifts sew . s P� Approval Certificate for e.00V /:, Ma/or Subdivision Plot •Tiffs r Plot dos,net Mow«y unf,tcornm,written or ntri u,d.n. roaemnt&dedlrofions a other encurnbranav&010 p .��.� this Rnol plan and Me shoot names shorn burden could grist an tints property and not upper on this plot. him-oneu mrarwnl \ .tt .N r�g' •11.•d<r 4 .'.� �2 f hOW been found t0 aompbr with the Acewrdingly,users of tints plot site warned to M,ok aei for the along Thy R/W line of \\PV- i� �. f `O• $vedivisi°n MpWOfans o/CalaaDo CwnO• «/sfnee°/such unracxdad burdens not shown Araan. sprfrrq,Rose on let 7 /0• 1, N. and were approved by the**Po County /ry�!� /A 5 Odwwy aV ® Manning UR•cror w WO*amt.*.All •the Pobd Nodgotfan Sot.*System(dISS)was used t0 [osern«f •*,Q limb,,,nlo antl after,104ed Aerfam fo grospotbl A«Ifbn .accuracy tanaard&port 1 J,p�'• 'miwammsnt,h ben installed*cording slanders Ia geode*net.o*at the 93E confdnce accuracy d, �� fa Jp*1Ocotlens eon,fanearda a ° faaai/°elion(951:conrdencs)uxhp real Urn*tdr,emefla the f0'a 70' ' �� d•r N r p.. of fen in s In n o!ton ra/owh hlamat c was used: Blot 7' • �( - 4 re000.0 impm y 00!n 10 amount and »w ���'• 1 % CNO Y°2 'a` manner soeeloo his U Catawba edfo Ms (Todnupo Benbg»certify that C mop vy,drawn under my 1 ,�, N uA, rb, ., s. s Dom n«nrd Ms"Mt q°pprvved/w auAerNs/an Fan n*fuel 6p5 navvy maw under my rupwvkbn �• »�'et Eaeawnf N� s�, recording In the Of ree 01 fht Register of and the IWorpq inf°rmgflon was used leg p.-lam the oyes., A� / `� 1, �,T� w q4. zip,-, Doe*of Catawba eaanty with sap•(GO pill/t $ N o .A. days alien eas rat ma- vat aaa of Survey CLASS AA O RGP city ua, "-�° ® ".�"� : / •% r- /) PoalllenaAeeureey aw•fie, 11.4 UI V t71 r N 0. I/i2 0,0.of OPS Rod 2/2/20n•RtK $• n0 ' O T. 57 'dNclW of Plans x aargn« Dal«Of Survey f2/2/20I1-8/t/2022 IV �n s Y0, a ; 2 .1 Dalum/Epodo NAD83(2011) v1f6 1 Lb, ,`R m y6 •'�' `.t w0/0 00./r1.ed-cronfra use VAS 1 ` .19, ' `�� "Is? -� b 1,,0' CEOID Model:2018 1 ` -' '� r® Is ^ • 0 10 0q3 Com.hed Grid Faefr. 0.99987078 1 �v _o N& y.a i• yg�ry �t Units:us Sunny rest 1 q1 Zj® ' e. ' C,t, ''d •Ares de tan*.by coordinate computation& 1 '6 y o 11•.41.-• •No/✓GB or NCGS NorfL Control Mawmsnt bone rHnh 2.000 JT� 'g �p Cloyd H. Propst. Jr. Todd' i sl a the site S i .Ssf ' b Ea Caterine E. Propel 1 a" �- tat `, Grog/"IS p� Judy P. Stevens •toffs)to 0•served by city wales and*NIP.sopl1 I 40e• �'To „0.,rare Lslah Ann P. Blodgett s 13•E j92• Et' 0.8. l7Be, Pg. 1108 •Property If*»NAN proximity of n agrkaWra district `I �S�• I,ygr 'N 7S� • I633e',R •VOW*ore underground 5 $• ® Total gSAe Note: •Rod maples frees planted no man Man S0 feel with Me w/a e N�yt ,E 33}.+e1 Hgnl-ot-way end°amply WIM NCDOT vegetation guidelines. 9.5 330 Contour lines eb sealed from •�. z t,1 O. MAa73,p0'13 Catawba 0)5 webalh. •man Is a 10'drainandsiren toc.1 „,,,„, N ', erg. y easement sang al lot lka& tut to •Told number or rot& 13 i' 1SOg, l pen3hs •T`Lol y'1 o�puu .uowwlon hor,w'certify ci er su survey m d ap unsd r my mpoM.1o. • \ a1_Ir Ina 73 p0,®g 1 yen F+ O ahato description pees.. tho Wad e .of GBook J719. .2.4ge 7- That itotnnds. y `1 tl`yn�� That ih'a prow moot.th.01..0*division of GI sl-der I nrnr • Y• 1 i AO. ,,y or.�!of a°t NU or»try*at* MA as on°o hennl land l Mahk ths �, ; j_y,.P"eyP 71 Ip ly^,TOIO a es- regulates nary*of land& •�'P1 c ts�Dmawy Iua D•� 97 ASGO 2 \ 1lnen this my alpha Ngn.tur®istration number and 1 t 1Nc UD = .,a e41�,;tt ^gr F=1 N T3' ©.a q v soot thle 2 °f August 2022 AO. N ' rL.?) � .L 7I y,i,cam 1 or'IS00 0 M"9 4 motel • �rNs."L_L• iaat—�f py\G•.M }y••�� 5>r V' .00"3'g 2 red M.14..e.b.#0C PLS Lana (74. 5r1q,'y: 1 _1 N 13 DO . Finn*kW/c-l39a 159r ` -O i 1 ® R t 1 -3175•. Non-oeera ,emenf ±,1 1, ISo°: Arta i r`. 4�} • along the"A;Ih.., 4) 0.97 Aere. 1110' }'• ,u..•1N�' E69 stand.tot 2 `.:: Melueng 0.21 Ann M R/W m.mR.nl !.' \IA '� aa Vol...other1*0 Ndkotsd erg*lancet Moan°n• 10'Reis 0 tt ,, hwhnfd ground alsfaneo 7 cnvert to geld Wotan& a004 the grand dtstan«by fine 1 1u 5 4 Wafer-Ones h>r r wnbNed f00Ir. la'Ra• � , l oils•am VW a �w :�: —' �� Review Officer Certificate SB'30 JJ '0,:n 0 a State of North Cumin. V - --�` \ Canty of*low* A/w , ram- In DIiVe - S.R. 151J /,1�iSoa�7dlyb eat R.Mgw Off*"/r cato.b. Legend 1 'lvW P.B. 6Rh�• `�`� courtly entry that Me mop w plat to which GP certification M CAPS ON MONUMENTS SET CONTAIN 7HE , 9 1� 5 omred mesh all statutory repuhtmnrle Its morass, SURVEYORS NAME AND LICENSE NUMBER. 1 1 4 /4�� — + O IRS 1/2"IRON R00 SET WITH YELLOW slip / iyc✓.! •BP f7.751WG IRON PIPE AS SHOWN Ravfer 011kr pale •D5.._.. EXISTING IRON ROD AS SHOWN 1 Lot I X CP........_ C011PuTED PoWT P.S. 86, Pg. 85 x Sss SURREY SPIKE SET y - u Ownership et Dedication Certificate `., MIcIMEillETTEME IMIIMMIWI M g UO7LJT•POLE m for Corporations, LLCs or Non-profits a S. i � x/� .6.......... nRf HYDRANT /(..)*try Nat 4 ern(Nb en)10 end aJ o/the Anp sly t' er <S1• 1>�f✓• IQ1fi t......_._. WATER VALVE a• I hse) owe«,Mich progeny h Ixaled ti)o the,u aporlen 3w ,, fib $:dim FlQli •............ ,PROPOSED RED MAPLE FREE �` tan pd,6cfbn eoegaoa Carry Nat'will a..y aabpl �>• ��RFIi RN._.........PARCEL IOCNARCA7ION NUMBER u....4. 00 p°:n a sua:tislof one :t oU ro puak use aN ones tr. c1.4. -5� • RCP...........RONFORCED CONCRETE PIPE «Ion•plot,uen e<slnN&alter&.M&pars,.rpm spec.aM Z t*� N::::1141119g.ma:=11.1.11MP:57; fP._..........EDGE OF PAI2MENT rq•f m•nl.e,ewt ewe rp¢irkay;neaeo,1 sir pnVale one deal 1 t� to WIN N .Qills........_NOW OR FORMERLY d (•.).W*Wein p Ives aws u.ls No oh of dedicalbn h 111yyy� t4•>•i rLE+ carried DY Ne nppnprbts puab aunMly Aa p/operfy Mew« f♦ fr , IP/1M...........NOT OF WAY .9 ale plot,dew tea Mr a puab me Moth he deemed to a A'1S...............---.LINE SURVEYED . aeava hd.d 4anyWoo'0d euub.Colavb out tN by row On woA NAM N o.0'�&7��T 1� G othoes MSLI•t:IFU•liti i�filAiii pp BMW�` TLO8144Em!Y e>_ ----_UNE NOT 9URYFYEO -4 L& tSC—Et LAVE SURTEFED a/. LGE OMB*AVM 1I•Um Only tfTl•f�I.FFS7i:^:•ti�51R•Ii -�RM,M-f7f-WAY Uri[ 9. Name e1 I then-pro AU Cur, Rodb. La,p% Chad Chord Boer. pe4.-012RHEA0 UTILITY LINE NfNl"'1• toitta 4 1 tE C1 _ 1T9.4a 10a44' Ic/.49• N 4704.36.w NdtW'duo!driveway easements on By(P eoldo'Es*whirs) to 0`0��1t-�-0 =0 100 240 1 .9 10'wide and ostnd horn centerline f eta of rood to 20'past R/W Rne os shown. t2•eR Afl«f(Seenfery.Igrrolw) aria GRAPHIC SCALE-FEET I. a 80' Shared dNJelrety eeaemenN an T Major Subdivision a. 20'olds 10'on each side of property a' Notary Bn.end*stand from the centerline I/2.OR Nan CwolHq Cole*Coup„ Spring Farms of road to 20'post RAE lino. as shown. Tilo LNrLISSA e.IMF 1 ,a Notary Punk Mf»M Clines Township, Catawba County, NC Ef2-yB©w < y ood.I0/.der Araby*try met w B;.ttyr Owners of Record: MartinRay Holding, LLC s/ /��jQ f u,-r,t! MOULTS elly ry Deed Reference: D,R J736, Pg. 782 !�"'"" f�/'"' e%f"'% ZoningMe dm&se*.of the Memo* w M tar one anena.Nag: NOTARY F`N Plat Reference: N/A PIN: J734-1175-2255 Proudly Surveying leaded County 20NWm R-20(Cafawba County) wm,e my hood n°arsard 4.44 �traLic Job Number.2111380S3.DWG (3111380.CRO) silo,1989 Busdho SstheeM Nts the a22",say of (IL24tt1 Sr 2o2x 2y Field Work: 12-2-2021 CV SIGNAL HILL DRIVE EXf STATESVNLE,NC 25023 mow-do' PHONE 70d 078-9661 L�yl.��1 gas Y1) L( ) rot.- ter sore �'`K�14Hk1 , w •,i Plat Date: 8-29-2022 www.bpundoryde.rlopmen t.aom per- 30• Marwy b wow, My COT Tin Mn.p..& `1te+LchIH,311.—_ Drown By WSR FILED Sap 06,2022 10:15 am BOOK 00044 CATAWBA COUNTY NC PAGE 0197 DONNA HICKS SPENCER 8LA alto IREGISTER OF DEEDS INST5 I9528 1 Catawba County Environmental Health 4 —4 •5216 262 45 3 •5210 AA 2CJI c9'n •1274 7 (233) ELGIN.DR 64 Parcel: 373411752004, 1274 ELGIN DR 1in=50ft CONOVER, 28613 This 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 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. Copyright 2023 Catawba County NC 06/21/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373411752004 Owner: MARTINRAY HOLDINGS LLC Parcel Address: 1274 ELGIN DR Owner2: City: CONOVER, 28613 Address: 114 MORLAKE DR STE 103 LRK(REID): 404974 Address2: Deed Book/Page: City: MOORESVILLE Subdivision: SPRING FARMS State/Zip: NC 28117-9211 Lots/Block: 2/ School Information: Last Valid Sale: School District: COUNTY Plat Book/Page: 84/197 Elementary School: LYLE CREEK Legal: LOT 2 PLAT 84-197 Middle School: RIVER BEND Calculated Acreage: .760 High School: BUNKER HILL Tax Map: School Map Township: CLINES State Road #: TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $0 Zoning2: Land Value: $16,000 Zoning3: Assessed Total Value: $16,000 Zoning Overlay: Year Built/Remodeled: / Small Area: ST STEPHENS/OXFORD Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Valid Sales (COMPER) for this parcel Contact Tax Dept. at 828-465-8436 Current Tax Bill Miscellaneous: Firm Panel Date: Building Permit Address Search for this parcel. Firm Panel #: If available, Building Permits for this parcel. Septic 2010 Census Block: 1000 links are not permits. 2010 Census Tract: 010202 Septic Final Permits prior to 08/2018, contact Agricultural District: Proximity Environmental Health. Building Details , 0 w LNka ALLA 1tt.ieA frr WaterShed: Voter Precinct: P33/Voting Map q 3R t ifs" Parcel Report Data Descriptions 35 List all Owners Deed History Report Assessment Report This 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 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. catawba county public health AO Id L Application for Environmental Health Services T '7 r 0 THIS IS NOT A PERMIT 435 Application is for: ❑ New Construction ❑Existing Facility ❑Improvement Permit ®Authorization to Construct ew Septic ❑ Septic Repair/Malfunction ❑ Septic Relocation ❑Septic Expansion Existing System Inspection or Reconnection El New Well ❑ Replacement Well ❑Well Abandonment ❑Well Repair Property Address 1274 Elgin Drive, Conover, NC 28613 Acres 0.97 ac Subdivision Spring Farms Lot# 2 Driving Directions to Property From Hickory,take Springs Street to Hall Street. Turn left onto Hall Street, and left onto Elgin Drive. Lot is located on the corner of Hall Street and Elgin Drive. Describe work Constructing new single-family residence. Applicant Name Larry Thompson Applicant Address PO Box 541, Midland, NC 28107 Phone 704-301-4881 Email larryAthompsonenv.com Owner Name Century Complete Owner Address 9325 Center Lake Dr., Suite 160, Charlotte NC 28216 Phone 704-488-1100 Email katie.dyess@centurycommunities.com Contractor Name Contractor Address Phone Email Name to Appear on Permit? ®Owner ❑Applicant LI Contractor Who will be the Primary Contact? ®Owner D Applicant 0 Contractor Proposed New Construction-Residential Primary Residence ® New Residence 0 Addition to Residence #of New Bedrooms*1 4 #of Occupants 8 Project Description Constructing a new single-family residence. Structure Dimensions,also specify dimensions of decks&porches 38-ft x 32-ft (Choose One) ❑Basement ❑Crawl Space ® Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ® No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) El Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑ Yes ❑No Describe Plumbing Needed (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes 0 No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑Community Well Abandonment Type 0 Drilled 0 Bored ❑ Dug ❑ Unknown RECEIVED E D Well Repair Requested 0 Yes 0 No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes 0 No JUN 2 1 2023 Environmental Health Environmental Health Catawba County Government Center,25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov • Existing Structures on Site Describe Structure Dimensions #of Bedrooms* #of Occupants Basement ❑Yes El No Basement Plumbing El Yes ❑ No Existing Water Supply ❑ Individual Well El Shared Well—Number of Connections El Community Well ®County/City/Township Water Line Is a public water supply available?** ® Yes El No Commercial El Proposed New Construction ❑Existing/Change of Use ❑ Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes El No #of Children #of Employees per Shift #of Shifts Commercial Kitchen El Yes El No Residential Kitchen El Yes El No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial f (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is"yes",applicant must attach supporting documentation. ❑Yes 121 No Does the site contain any jurisdictional wetlands? ❑Yes ®No Does the site contain any existing wastewater systems? ❑Yes ®No Is any wastewater going to be generated on the site other than domestic sewage? Yes 9 No Is the site subject to approval by any other public agency? Cif Yes No Are there any easements or right of ways on this property? Describe 0 I i v?W4( taSeML,tt If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) {a Accepted 0 Alternative 0 Conventional ❑Innovative 0 Other 0 Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. **If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. Completed applications are valid for a period of 2 years.Improvement Permits are valid: with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct,issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or le a oft wner. Signature of Owner or Legal Agent_ Date 06-20-21 Printed Name of Owner or Legal Age t Lar Thompson -v,A co CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 INVOICE/RECEIPT U` y;� PHONE:828.465.8399 Wednesday,June 21, 2023 118 4 2 sM www.catawbacountync.gov Invoice Number: 06-23-424377 Invoice Date: 06/21/2023 RBPR-06-2023-44701 CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: 1274 ELGIN DR,CONOVER NC 28613 Applicant CENTURY COMPLETE,9325 CENTER LAKE DR SUITE 160,CHARLOTTE NC 28216 B:7044881100 KATIE.DYESS@CENTURYCOMMUNITIES.COM Paid By *WJH LLC,9235 CENTER LAKE DR STE 160,CHARLOTTE NC 28216 B:3362823606C:7044881100 KDYESS@WADEJURNEYHOMES.COM ACCOUNT:7554 PAYOR: *WJH LLC FEES RBPR-06-2023-44701 FEEAMT DUEAMT AOWE 110-580200-663000 06/21/2023 S135.00 S135.00 FEES: S135.00 $135.00 TOTAL FEES: $135.00 $135.00 invoicereceipt 06/21/2023 12:35 Page 1 of 1