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RBPR-06-2023-44703.TIF
g 6pg .us•)o)3 • it '7D3 y,�sT0.rE4Ho ROY COOPER •Governor %' NC DEPARTMENT OF < 1 ,� � KODY H. KINSLEY• Secretary ;; l _, p HEALTH AND HELEN WOLSTENHOLME•Interim Deputy Secretary for Health �" HUMAN SERVICES 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: NIA 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): 5216 Hall Street, Conover, NC 28613 (PIN: 373411751261) 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: 0Place 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 ❑■ No A site plan as defined in G.S. 130A-334(13a)is attached: ❑■ Yes ❑ No 11. Location of proposed or existing wells(drinking water, irrigation,geothermal,groundwater monitoring, sampling, etc.)and any potable and non-potable water conveyance lines is indicated on attached plans and complies with 15A NCAC 18A.1950: ■❑Yes ❑ No This is a saprolite system. ❑Yes ❑■ No 12. Evaluation(s)of soil conditions and site features in accordance with G.S. 130A-335(al)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 ■❑ 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 a activities determined to be engineering as determined by the North Carolina Board : :t:: r ! a::: :: f Einers for 06-223 ator. wrier self-submittal of NO1: hereby submit this NOI prepared by Print Nome of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Dote DNNS/ENS/OSWP-AOWE COMMON FORM Updated April 2022 Page 2 of 6 AOWE Common Form LHD Reference: 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 AOWE Permit Option(G.S.130A-336.2ff)J RIGHT OF ENTRY: The submittal of this Notice of Intent to Construct grants right of entry to the Local Health Department and the State to the referenced property. ISSUANCE OF BUILDING PERMIT: Once the LHD deems that the Notice of Intent to Construct is complete via signature in the section below,the owner may apply to the local permitting agency for a permit for electrical,plumbing,heating,air conditioning or other construction,location,or relocation activity under any provision of general or special law pursuant to G.S.130A-338. DHHS/EHS/OSWP—AOWE COMMON FORM Updated April 2022 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 deportment shall make a final determination as to whether the notice of intent to construct is complete within five business days after the department receives the additional information.If the local health department fails to act within any time period set out in this subsection,the owner may treat the failure to act as a determination of completeness. The owner shall be able to apply for the building permit for the project upon the decision of completeness of the notice of intent by the local health department or if the local health department fails to act within the five business day time period." The review for completeness of this Notice of Intent was conducted in accordance with G.S.130A-336.2(c). This NOI is determined to be: ❑ INCOMPLETE(If box is checked, Information in this section is required.) Based upon review of information submitted in Part 1,the following items are missing: Copies of this form listing missing items were sent to the AOWE 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 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 . Dote Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date DHHS/EHS/OSWP—AOWE COMMON FORM Updated April 2022 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 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. 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. 1HD 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 Dote 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 Date Email,FAX,LISPS,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/EH5/OSWP—AOWE COMMON FORM Updated April2022 Page 5 of 6 AOWE Common Form LHD Reference: PART 3: Authorization to Operate(ATO) Except for date received,the Section below is to be completed by the Owner. LHD USE ONLY: Initial submittal of request for ATO received: by Date Initials Date of Post-construction Conference: 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 ❑ 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 ❑ COMPLETE Based upon review of information submitted in the Section above,this Authorization to Operate is hereby issued in accordance with G.S.130A-336.2(m). A copy of this complete NOI/ATO with tracking information was sent to the State on via Dote Email,FAX,USPS,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. J DHHS/EHS/OSWP—AOWE COMMON FORM Updated April2022 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 Signature: Owner Signature: Date: Apr 19,2023 Date: Residential Subsurface Wastewater Treatment and Disposal System AOWE Repair Permit for Lot 4 - Spring Farms 5216 Hall Street Conover, NC 28613 Tax Parcel Number: 373411751261 June 20, 2023 Prepared for: ,Q sOI[ ' per t.00vp6,0 o�le,,,, Century Complete � ; -� .. `',, - 9325 Center Lake Dr., Suite 160 Y'"{ .4 + „ Charlotte, NC 28216 'V. ' + �° 704-488-1100cleAtv iz8� TM Prepared by: Larry Thompson, REHS, LSS , ...jb W Thompson Environmental Consulting, Inc. PO Box 541 C u� •` Number t fa zz Midland, NC 28107-0541 • a Phone: 704-301-4881 =_ • • "�©016E • larry@thompsonenv.com •• •' Lot 4-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 4 - Spring Farms, 5216 Hall Street, Conover, North Carolina (Catawba County Parcel Number: 373411751261). 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 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) with a Horizontal Prefabricated Permeable Block Panel System (PPBPS) repair area at a 0.3 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 the lot is located on the left. 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 4-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 eight, (8) lateral trenches, a 3-foot wide by 50-ft long. Total trench length is 400 feet. 5. The maximum trench depth for this system shall be 24 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. The drainfield shall be shaped to shed rainwater and be free from low spots. 2. 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 4-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: (8) 3-ft Wide x 50-ft Long Total Trench Length: 400 Linear Feet Maximum Trench Depth: 24 Inches Required Soil Cover: 6 Inches Repair Option Effluent Loading Rate: 0.3 GPD per sq. ft. Drainfield Type: Horizontal PPBPS Required Linear Footage: 267 Linear Feet Lot 4-Spring Farms Available Linear Footage: 330 Linear Feet Maximum Trench Depth: 24 Inches Required Soil Cover: 6 Inches A DATE(MMLDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/7/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: David Vaughan Higginbotham Insurance Agency, Inc. PHONE FAX 500 W. 13th Street (A/c.No.Ext):9187797880 (A/C.No):817-882-9284 Fort Worth TX 76102 ADDRESS: 99 dlvl r@ hi inbotham.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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MWDD/YYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY 04-GL-001086672 9/25/2022 9/25/2023 EACH OCCURRENCE $1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea 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 JECOT- 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 STATUTE ERH AND EMPLOYERS'LIABILITY Y!N ANYPROPRIETOR/PARTNERIEXECUTIVE N!A E.L.EACH ACCIDENT $1,000,000 IM OFFICEREMBEREXCLUDED? (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 1 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 5pylaj •ray-itv6 LiS)- " qD keg 1 �a la s5`No 0 sse Pe? 0 1'N° s5' Pee ss' peP. 5s'et() r so , Ze. , (a 6eph 4 snag+ 15' Thompson Environmental Consulting,Inc. she,_ PO Box 541 PROPERTY ID#: Midland,NC 28107 couNIY: 37( bor SOIL/SITE EVALUATION for ON-S..E WASTEWATER SY ,TEM 30( OWNER: 1J DATE EVALUATED: LC) ; ADDRESS: JJ PROPOSED FACILITY:__AL244#21—PROPOSED DESIGN,FL �.l949):4t) PROPERTY SIZE: LOCATION OF SITE:_ 5-at(J' t.) PROPERTY RECORDED: WA 1'ER SUPPLY: 0 Private aPublic ❑Well 0 Spring ❑Other EVALUATION METHOD: �uier Boring 0 Pit l0 Cut TYPE OF WASTEWATER: Q.Bewage 0 Industrial Process ❑Mixed P R SOIL MORPHOLOGY 0 HI ER F (.1941) PROFILE FACTORS I .1940 I. LANDSCAPE HORIZON - PROFILE POSITION! DEPTH .1942 # SLOPE% PI) .1941 _1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR <AR TEXTURE. 1.MINERALOGY COLOR DEPTH CLASS HORIZ D-Acl 5c. A —W,-5(0 (-)5 1 L q _. 5f(le 3T 0- tiff Sc. thk. -r.ss5e r' 5-- L qr( se 2 11 C� • 0-95 64- : spa`', �., - + J t , ,a. � 7 9-L 1,� s sue' ce- 4 (Di- DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): , • f - SITE CLASSIFICATION(.1948): Brows'.er ^F Available Space(.1945) PS PS EVALUAIEllBY: 64Let ►t� e • syt�nTyre(6) Accepted PPBPS P OTHER(S)PRESENT: 4, .cr �t r Site LTAR 0.3 0.3 L. Thompson, LSS At ` iF,.'~3�'. ` COMMENTS. lap 'i# __ tiC.j Updated February 2014 _ '` C • Quick4TM STANDARD CHAMBER — 52" 1 Quick4 Standard Chamber 48" .- (EFFECTIVE LENGTH) ,\i a eE Qe 6 tor 1= m wag ®meor ices=0 = - 34" SIDE VIEW SECTION VIEW MultiPort End CapIlMI • 16" r h 12" 11 ikl�� 101 IL A killkji � I 1 - 1 �4��tit11111111�'� 34" SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (WxLxH) 34"x52"x12" Size (WxLxH) 34"x16"x12" Effective Length 48" Invert Height 8"or 1.25` Invert Height 8" INFILTRATOR SYSTEMS.INC.STANDARD LIMITED WARRANTY dal The structural integrity of each chamber,end plate.wedge and other accessory manufactured by Infiltrator I"Units'),when Installed and operated 'a a hchfield of an onsite septic system in accordance with Inlltratcr's instructors,is warranted to the original purchaser rHolder")against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units:provided.however, that if a septic permit is not required by applicable law.the warranty period will begin upon the date that Installation of the septic system commences. To of the its warranty t.I rights,Holder must notify infiltrator in writingst at its Corporate Headquarters in Olde b,thisLimited Connecticut Warranty Meer(15) I N FI LTRATO R days of the alleged detect.Infiltrator vn'H soppy replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty 1 Infltrator's liability specifically excludes the cost of removal and/or installation of the Units. THE UNITEDWAFlDING OIMLIEDWARINSUESOFMERCH(a)AOR . SFOARP NO ULERWARRANTIESWRHRESPECT SYSTEMS INC TO THE UNITS,INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Ic)This Limited Warranty shall be void if any part at the chamber system Is manufactured by anyone other than Infiltrator.The Limited Warranty does rot extend to incidental,consequential,special or indirect damages.Infiltrator shall not be table for penalties or liquidated damages,including loss of Environmental Onsite Wastewater Solutions'"' production and profits,labor end materiels,overhead costs.or other lasses or expenses incurred by the Holder on arty third party.Specifically excluded from United Warranty coverage am 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 m other conditions which ere 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 instatatah instructions:the placement of improper materials into the system containing the Units:failure o1 Old Saybrook, CT 06475 the Units or the septic system due to i Inn uper siting or improper sizing,excessive water usage.improper grease dsposel.or improper operation;or eny otherWarranty. event not caused by Infiltrator.This Limited Warranty shell be void it the Holder falls to comply with at of the temps set forth in this Limited 860-577-7000• FAX 860-577-7001 Further,In no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units,or any third party resulting from Installation or ship. O p 00_L L`1 r�1_443 V C inert,or from any product liability claims of Helder or any third party. For this Limited Warranty to apply the Units must be installed in accordance with all site conditions required by state and local codes:all other applicable laws:and Inittretore installation instructions. 14 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 altered by Infiltrator.A limited number of states and counties have different warranty require- meets.Any purchaser of Units shoud contact Infiltrator's Corporate Headquarters in Old Saybrook.Connecticut.prior to such purchase.to obtain a copy of the applicable warranty,and should carefully read that warranty prior to the purchase of Units. U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 ,L Canadian Patents:1,329,959;2,004,564 Other patents pending. s_'Infiltrator,Equalizer and SideWlnder are registered trademarks of Infiltrator Systems Inc.Infiltrator Is a registered trademark in France.Infiltrator Systems Inc. ~ is a registered trademark in Mexico.Contour,Contour Swivel Connection,MicroLeaching,PolyTUft,SnapLock,ChamberSpacer,PosiLock.QuickCut,QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc.0 2003 Infiltrator Systems Inc.Printed in U.S.A. 0011203HP-0 Flood Hazard Area Certificate ® TwW Dare Rd Aacorch4 10 mapping pnd0ed by!ha ot.0 Emergency Management Agency and ,y shoed an the Dgdld need Mturmn Row Np grieve))P*W J2J4,Colo. " Ir County North Carolh4 el..data ,06 navel A 2007,Um property sham M tram le not baled OM 0 spade.Need hareel and 11.1 property a 9fM, r• d (1.0▪ m red 0•e/pt,. 'lone X-other ones',AMI del..*to be outside /f f _ s." �•Il. Eno 0.7A annual Moon Noadpla n areas oafs..oblun conditions IS annual d, / chants Noadpalk /� Watershed Certh7cate: re Ina bear ear my mown.Inn pat do..our.waNn a viler /A l Y7 3/A aepy rebated onewoled by the North Co.*Division of ��/ Casting Ad. fnwenenenta umepemeat os dean m the*tow.'PnrscLw 0.p Inn of Cal000a Cowl.Nem Cerra. Environmental Health Approval of StibdM•lon Plot / This finial plat and lots shown how boon opprowd b the d' yG Environmental Wealth Gaston of les[clawed Coono ~ p R aportm.nt el Public Ni.IM. I J/�� � Vicinity Map(MS) //+ter Pit,k q�22 ' / Notice EnvaonmNfol NsaIM SupeMrr or Design* Pete \`' Ej• ��1111r .1 •Paul w0 1 to any s rrig7tta:nor of way*newt i f . ��e ono m r�Cvglwa«nents*a rynr.or wa. •ma srwy a sub,Y f to any rota that mey ao asaasw by a �^9 vo-000- APB A i,• ® Approval Certificate for •4,and aaaarat.Nii sN ah. la��{�1v-s Major Subdivision Plat •Ibis slimypat does not show anyunmoor.e eaten or C a / •.�� `A..'An urn..easement.dedications l,d ennmbroncea.Such NNN a Mb final Pet rK fen rfroot names shown burdens could east on Lisa property d not appear on this plat. Non-owess fawn. 6 Sic 'n o N her boon found to comply nth eh. Aceenhpl.users of this plat an earned to rona.ern for the Wong the II/W lino of tp •i 4. N y S 'd..*Plot.of Catawba Cow* exist**of such v ...tl burdens nal sham hereon. Solve Road en ia4 7 ,/e' ..1A• Y iS and n opprowd by NO Colombo Coun* / . Dlvp.ey a`�!y, ® PknnMq tier ar hi/hoer design*.Ad •fie Global NodgolMn&Heats.Swim(GLASS)wad used to A [aesmwH 't2.4 /M.ts, mts d other Weed stand. to gNodetk Mons a am**atondaede,part 2 �' V if to specification. menls hem been*Weed rcaroeP atwtlrs for pao0etk nofwak.at Its.93.8 confide*.aecurocy • �• ,0� to pepncat/on.and standr*,r a doaailoetlon(95.t'confidence)*big real time kinemalle me IV re 70' i N guarani*of rid bufalbWn of U. following hfrmefl*sas uNQ• 9Iph1 - �, 9 rewind improvements M of and Y �' monnr seefact o CoMwbo Coun Ives �t \ 4'��eO?�, me fy I,red Benbow certify that fills map was droll 0/00 my e'.� \ N ma �, been noNwd. !Mi pot le opprowd for supervision,Yin m actual GPS aura OIr y Tan under Ty wpeMaan [Moment V saw Y �. a recordvlp le the n o/fA0 Register or end NO IdlawMp information wed end la perform On wrw. �r �• • Y i a�O bath of Caewbo Caw* !thin ship(e0) y(e'/ $. N Via ® doya/I fin/de/rrya f tAh aoruwt alas.w Surrey CLASS M P Ittf Ii�'41 -.a S, -,b >y V i + /!. / e.0 �_�i 4/2„, / Poslrbnd Aceuroex Gas' to `4 4'... tA� `11V, SL >r •} ° 'U"nctr of P � 7•.!i=2 Tjpe or G?S FWd Procetlurw•RM S. -� p r Cosign* Da a Doted of su ie 02/2/20a1-6/8/7021 a \71 QNO • ,, Y Doeum/Fpoch:NA08J(2010 pill I C• 'ae ' a . PUMhha04011 2-cwINJ Ww IRS \ Y�m' °�, ry6sGEOID Hod.p.sore 1 + �®.•°%s k'74l' (Mx US old r«tor Gpsee7o7e pp (t% a.� �G fLr•� tANta:Ds Gravy tier 1 "r-' (3a� �iO' II- ' r5`tt• •kN tlafennhed by cordhare camputollona I \ tit S ar , A1.- e-. 'Tj ,a 9. • ' • T Cloyd H. Propst, Jr, "road' Poot aI Me armHr4 C*Mr Nahum*f ound wmh Woo° e te ,�ap�a EoGaronne E. Propst11 ` ga tote. �peW N N13c Judy P. Stevens •let(,)le be served by coy rotor end individual sop*. 82' - Letgh Ann P. Blodgett 13•E j92• Q D.B. 1788, Pg. 110e •Property Ives mats.proximity eon ogrkuaurol district. ,1 '�y0o 1�97' •N 13. Ie.so' •UMW*r....ground �. ®.a Tot01 �S Note: •Rea mpf.o froth a*led no men than 10 feet Wt.U. _.p-- N ww •E j33•N� .1., right-of-way era tamely wlrn NCDOr wpetauon*Wed. 9 yralo.� Contour sines on scaled from $i z a\\ ,.,9.7 700® 316 Cotawbo GIS webs*•. •mar.Is a M'drohoge end anR t along*lot linos. y aasemm q a`- CIA •Total number of Iota /y13 IV° I Tod U.8entrow,11 m-• • .. In R 7r,TOta1 wit .041.4 k.l from wroeluaf sorrat by made undo,m super 1•02 draw under vision a0 W 15. _a\ • 13• G le 3 8,' (deed**nation resided h B0ak J738,Pee 782) Thal thM w\ 1r10tn0°,13 E ill() plot was prepared h accordion wfu GS 47-30 es om*den 1 `r 73 h Y fin!Ih4 blots moots Me n.0,000 a/QS 17-JG f Nrtnr IP%\ as N ® Wf crrny Mof Nb survey roots,o subd/Hrion I Iend wlthh M. \ C° Nj0 red or a trolly r munk/polfy that has on adN*cr Mot y73 a' `_,art O.os 1:~y9r445,Total regulates preNe el road 4 0 1 F**,antyld�wo00'13 E IP' 2 i w7Mese MO my rg1r*rotor.registration number.and ',S\ N 1S ® y seal idle 2 of August 2022 A.D. A e►e ROC' RP' tat •8 rlpq• yJ \ e• 1bAg• 9.Oi."�i 79�44 70 a Q b -J775 ',-��Y�.CsSI(ff)".4 TA R 5?)`'' 1 \\ ,_1f1 N� 0't3, fain Lk.*/c-1598 k 'r)• I • SFJ1{.® 1t.w� L-3175Non-aanw semml 5\ 1D•p°. Area p 'c '�• along two it.Ono r \• ~.3a,¢4.0 . Ma Sent on Lot 2 111,ryg Including 0.221 Aare InVW y OnVesKry of 1 f IO' ��' 1 }1 tore,.oNro.o h00700/ all convert shown aI' I8•RCP DsAvwq bra*Id ground the ground To cenwl to peW 'aid 0*n. mutter M.Around dNf.»n by In. 1 ` "'II 4 WbIV WM.�T x � ` own.*fetter. ■ --X----g—�'f-ia'RCP � � • i.V#'8# "�u'r� ���.._,..ii"i'—"� Review Officer Certificate 0 a \ stet.of Nall Carolina 5 88'JO-S �* County of Catawba Legend R/W' ��_FtyM Drive —----- S.R• 1513 SS \ L t•laibe.11\..bae\r Red..OmaererrGator. 9 \ d0•RAV P9 ft PO' 83 \` \ County certify Mot the mop r plat to which Ma cerNNcofan a CAPS ON MONUNEMS SET CONTAIN THE ; q„ \ ��aa affixed meets W statutory npuprn*.N Mr ncwOh$ SURVEYORS NAME AND LICENSE NUMBER. � ` O VS I/2.IRON NOD SET WITH YELLOW CAP 'e \ '' o1c i.���"<�'4T 07'L'j_ •VP VOS 'c IRON PIPE AS SHOWN , Raver Officer Dab •LIR EXISTING IRON ROD AS SHOWN Lot $ crr X CP........- COMPUTED POINT P.B. 66, Pg. 88 I. )I(SSS SURVEY SPIKE SET Cove. 8•Mnp Galanee s»rEEr s w Ownership 8: Dedication Certificate 1% s 2916'06" 0743' 7,'1 16.72 fJ.....•-..•••••.••.unMr POLE Z. for Corporations, LLCs or Non—profits s S$,•77$•)$" 09AV b................_ nRf M9RIM # N u'24'7" 70' �y I(we)ert&ow E o„(WY rot the eN�)et the prprli' t• • WATER 00 0 T p .,deed Naar,,+Aldl Pprly a ladled shots M•f adl.Nbn 3 N aa42• " 2.Iyy PROPOSED RED MAPLE TREE I. Han 1u4aalw ear Gelar60 County Inr I(IW)neeb adopt o N 6022'Sd" 42.07' PIN PARCEL IOEM/7/Ar5ON NUMBER 1,, Ills pan of win .n and Q*We to*elk vs.as areas sham 9- ^as.. 1 N SB)4'JJ" ,7°,Aa' RCP REIWOACED CONCRETE PIPE m fee pot such os street.*sy.wont parks.pen apace and .'A. Sea N Se)6']J" .e EDP Qs.PAVEldE70T r woements,except those apsciR.in...as prior 11,and hat I as a sa,s i , NAP NOW OR FORMERLY '� (W1 net mohfoM all said row anti the offer of Oedkptlm I. 'T• 1 -1T WWS.' 'yi.L' webfoot by Ma epprep0,/k,,subway Ad properly snowy on �1 4753'1' 'l.1; R/N RIGHT OF WAY m Ma plot,dedicated for a puNk rt a0OI be daln•d to be N1 N A7yy'21" N!S..,,.,.••••.....--.LOVE AMMO 1.'ems dedicatedM.s for*oPprowe by public olo.We C use hra by low*an such tlN a114 1'2Sy1:: 'j'�i$¢' lif LINE smog) yO 7�, �(I LLISIMp Ara 7.Linn Only ,� s 6 ''SA" 57.1a'1 a . ...910E NOr SURVEYED None or 1 Non-prom) Curve Radius L•ngth ellard Chord Beer. �RlOHI-OF-WAY LINE 3 _aE—OVSRHEAD NARY UNE Ming(4 gye'lIMAM ClC1 1AM - 14QM' 181.6Y N 12•04'38'W (Pr..*Note: Il (Pr..*sign.* `W' t. BO 0 B0 1B0 240 Individual drivewaoyy easements an ■�' 10'wide and extend from centerline f �� o/rood to 20'poet R/W/ne as shown. 1/2• Att.(S..,..plai) 0.1. GRAPHIC SCALE- FEET 1• w 80' Shared driveway easements em.nt.a Major Subdivision of•• 20'wide r0'on each stele of property $ Notary Spring Farms line and extend Worn the*Merl. 1/2'Eat Nor0A Caroline,Colombo Gamey of road to 20'post R/W line.os shown. Tarn Lf1FL/SSA6.MRTiligl7S,eh RA.ler.a1 Clines Township, Catawba County, NC comfy and slag.hereby re y Not e..kq Owners of Record: MortinRoy Holding, LLC $�}yB0w f)dSTrrJ A4eCtd[kw �nesm ry Deed Reference: D.B. 3738, Pg. 782 .i ✓ C�,� Me ue«w,tion of 1 oA egoble herume,n 7 and °N"e NOTAsty 1/I Plot Reference: N/A _____c '0 Zoning PIN: 3734-1175-2255 Proudly Surveying lode/Covey zomm2 R-20([oloeba County) 0Mea.my hind and elecl4'0004 l�f DLit Job Number2111380S3.DWG (3111380.CRD) slaw 198B MOM,subew tees or d NY of &Ur It. zoiz Feld Work: 12-2-2021 870 SIGNAL HILL AWYE&YE,STATESHLLF,NC 20822 nrM-Jg• PHONE(704)876-9661 Wee_ l8• -) I•' ` `+20eal ilty laud ,�,E cal6 Plat Date: 8-29-2022 no.w.boundor evelo ment.com Na,r Vabra •uan yd p Real- so• Ny a'nmadan o.pbar_Ll(�heti IH.3fl.2•t_ Drawn 8y: WSR BOOK 00 48.2022 1T WBA BOOK 80088 NNA HICKS IPENC DONNA HICKS SPENCER 81.L .1.1. \ C\1 PAGE 0197 REGISTER OF DEEDS INST 6 19528 Catawba County Environmental Health 7 9 4.04 3 A9 6 10691 •5228 318•A6 5 co J •5222 - ,.a (4)30p 47 4 v •5216 010 3 w 9 •5210 AA 264 J 2 cn 147. •1274 Parcel: 373411751261, 5216 HALL ST 1 in=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: 373411751261 Owner: MARTINRAY HOLDINGS LLC Parcel Address: 5216 HALL ST Owner2: City: CONOVER, 28613 Address: 114 MORLAKE DR STE 103 LRK(REID): 404976 Address2: Deed Book/Page: City: MOORESVILLE Subdivision: SPRING FARMS State/Zip: NC 28117-9211 Lots/Block: 4/ School Information: Last Valid Sale: Plat Book/Page: 84/197 School District: COUNTY Elementary School: LYLE CREEK Legal: LOT 4 PLAT 84-197 Middle School: RIVER BEND Calculated Acreage: .500 High School: BUNKER HILL Tax Map: Township: CLINES School Map State Road #: TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoning1: R-20 Building(s) Value: $0 Zoning2: Land Value: $12,800 Zoning3: Assessed Total Value: $12,800 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. 11 ,^, ,r p Building Details b W� �V�I\u� ill "ikr WaterShed: j ( ,2 R L /-3,1 Pci Voter Precinct: P33/Voting Map , Parcel Report Data Descriptions 3 G 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 y y7o3 n'" Application for Environmental Health Services ,L'' 11 W THIS IS NOT A PERMIT / 1?j�j Application is for: ❑New Construction ❑Existing Facility ❑ Improvement Permit Authorization to Construct ;New Septic ❑Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion 0 Existing System Inspection or Reconnection ❑New Well ❑Replacement Well ❑ Well Abandonment ❑Well Repair Property Address 5216 Hall Street, Conover, NC 28613 Acres 0.53 ac Subdivision Spring Farms Lot# 4 Driving Directions to Property From Hickory, take Springs Street to Hall Street. Turn left onto Hall Street and the lot is located on the left. 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 0 Contractor Who will be the Primary Contact? ® Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ® New Residence ❑ Addition to Residence #of New Bedrooms*f 4 #of Occupants 8 Project Description Constructing a new single-family residence. Structure Dimensions,also specify dimensions of decks&porches 38-ft x 37-ft (Choose One) ❑Basement ❑Crawl Space ® Slab If Basement,Will There Be Water Using Fixtures In Basement El Yes ❑ No Retaining Wall>2' ❑ Yes ® No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' 0 Yes 0 No Accessory Structu re(s)Describe Structure(s)Dimensions Plumbing 0 Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' 0 Yes ❑ 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 ❑Yes 0 No Retaining Wall>2' ❑ Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes ❑No Describe RECEIVED Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes ❑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 ❑ No Basement Plumbing ❑ Yes El No Existing Water Supply ❑Individual Well ❑ Shared Well—Number of Connections ❑ Community Well ® County/City/Township Water Line Is a public water supply available? ** ® Yes ❑No Commercial ❑ Proposed New Construction ❑ Existing/Change of Use El Repair Food Service Specify Type _ #Seats Dining Area(Sq.Ft.) _ #Employees per Shift #of Shifts Church #of Seats Daycare❑ Yes ❑No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑ Yes ❑No Residential Kitchen ❑Yes ❑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 t (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 ®No Does the site contain any jurisdictional wetlands? ❑Yes la 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 01 No Is the site subject to approval by any other public agency? Yes ®No Are there any easements or right of ways on this property? Describe pi; vevu4i, rkseweitt 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) la Accepted 0 Alternative 0 Conventional 0 Innovative ❑ 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 lea oft caner. Signature of Owner or Legal Agent r Date 06-20-21 Printed Name of Owner or Legal Age t La Thompson �'A COS CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 INVOICE/RECEIPT VPHONE:828.465.8399 "941P Wednesday,June 21,2023 //8 42 sM www.catawbacountync.gov Invoice Number: 06-23-424379 Invoice Date: 06/21/2023 RBPR-06-2023-44703 CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: 5216 HALL ST,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-06-2023-44703 FEE AMT DUE AMT AOWE 110-580200-663000 06/21/2023 $135.00 $135.00 FEES: $135.00 $135.00 TOTAL FEES: $135.00 $135.00 invoicereceipt 06/212023 12:38 Page 1 of 1