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REF- PO o b 31f 6'&7 SIB(-GoJ Pis' ned PEE-Frown LeeacY 5s, Case +0 Co(1ecf-flew er i f -fees Affig.61,-)v)3 .voqs ( EF- DoOb 6�f � STATE, , A G w I� 06. 2- C 2 letg O g M �, ROY COOPER•Governor �P`� i3 ��I NC DEPARTMENT OF s KODY H.KINSLEY• Secretary i !'__ ` HEALTH AND you {•% } • op HUMAN SERVICES HELEN WOLSTENHOLME•Interim Deputy Secretary for Health ' „,.• '!'" 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: (" 2 U' 2-3 by e ro 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.): Adams Homes-AEC, LLC Mailing address: 3401 St. Vardell Lane, Suite B City:Charlotte State: NC Zip: 28217 Telephone number: 704-558-4527 E-mail Address: bcashion a(�adamshomes.com 2. Authorized On-Site Wastewater Evaluator(AOWE)name:Jeff Vaughan LSS License number:1227 AOWE Certification number:10003E Mailing address:501 N Salem St, Suite 203 City:Apex State: NC Zip: 27502 Telephone number: 919-859-0669 E-mail Address: jvaughan(aagriwaste.corn 3. Licensed Geologist(LG)(if applicable)name: 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 Let C2 Cardiff Court, Catawba, NC. 28609 (Cardiff Glyn Subdivision) LOT 61 Amended based on PLAT dated January 26,2023 County Name: Catawba RECEI VED ECEIV - 0 NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH J U r'• / 0 2023 OCT 1 6 2024 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 vironmental :alto Environmental Health AN EQUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER AOWE Common Form LHD Reference:No lvE p6-7023— 0s/d 6. Type of facility: E] Place of residence No. Bedrooms:4 No. Occupants:$ ❑ Place of business Basis for flow calculation: ❑ Place of public assembly Basis for flow calculation: 7. Factors that would affect the wastewater load:domestic strength wastewater from a single-familv residence 8. Type and location of proposed wastewater system: Pressure Manifold 25% Reduction Chambers drain field product Location shown on site plan 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 J 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 1,Jeff Vaughan 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 and activities determined to be engineering as determined by the North Carolina Board of Examiners for Engineers and Surveyors. f //f if/ ` _ June 13, 2023 Signature of Authorized On-Site Wastewater Evaluator Date Owner self-submittal of NO!: hereby submit this NOI prepared by Print Name of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner RECEIVED Dote OCT 1 r -74 DHHS/EHS/OSWP AOWE COMMON FORM Updated April 2022 Environmental Health Page 2 of 6 AOWE Common Form LHD Reference: A-0 14.6-06-Z 013-t l0 611 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-336.2(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. RECEIVED O C T 1 6 2024 EimAronmcntaI Htcc!th DHHS/EHS/OSWP—AOWE COMMON FORM Updated April 2022 Page 3 of 6 A 6 AOWE Common Form LHD Reference: 0h E-b6 202�j- /if 6(S 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 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 Nome of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Dote Vjr 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 U�J3��3 via h►"h r` Date Email,FAX,USPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered 12_,-1fin, �1t,k_ ; — 6—z2—Z3 Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Dote O C T 1 6 2024 Envfronmental Health 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 Jot 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 Department use after submittal of items noted as missing above. LHD Follow-up Completeness Review of Notice of Intent to Construct This follow-up review for completeness of this Notice and Intent was conducted in accordance with G.S. 130A- 336.2(c). This NOI is determined to be: ❑ INCOMPLETE Based upon review of information submitted in the RESUBMITTAL above,this Notice of Intent remains INCOMPETE because the following items from Part 1 of this form remain missing: Copies of this signed form were sent to the 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 Date Email,FAX,USPS,Hand delivered A complete copy of this form with tracking information was sent to the State: via _ ai bS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date OCT 1 5 2024 DHHS/EHS/OSWP-AOWE COMMON FORM Updated April 2022 Environmental Health 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 Li No 2. Operation and management program [1 Yes l 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 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 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 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,LISPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized AgentrlWLc ' rED 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. OCT I ?4 Environmental Health DHHS/EHS/OSWP-AOWE COMMON FORM Updated April 2022 Page 6 of 6 k — ttl!" i °s• 1 °,- . ilik I 1 1. HiY» 5 ! i `' w 8= �ozN g '�`'h ;,". 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Ca 0• z {{ 4,� a 4 61.0,`S#s0 Lam It fA O LLI ..a: H 3 iii . .�m D T 1 1J 202 co a 0 o __", � y c y -}I •, ~ @ m n Q m� Q"g g8-oN aLLrn LU Environmental Health o y 3 a.3 a m o.:o o O o�m O u_ W-01- in t ' Abfig.bk-7o3-iitillis oM TTf�o AowE-o6- zb23 -let3o3 ROY COOPER•Governor f: ' �„ 3 .. - NC DEPARTMENT OF KODY H. KINSLEY• Secretary oil HEALTH AND HELEN WOLSTENHOLME•Interim Deputy Secretary for Health . .!;4:.;' /§ HUMAN SERVICES 'M!•¢'0 4 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: 6 — to- 2-3 by (te 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.): Adams Homes-AEC, LLC Mailing address: 3401 St. Vardell Lane, Suite B City: Charlotte State: NC Zip: 28217 Telephone number: 704-558-4527 E-mail Address: bcashion@adamshomes.com 2. Authorized On-Site Wastewater Evaluator(AOWE) name: Jeff Vaughan LSS License number:1227 AOWE Certification number:10003E Mailing address:501 N Salem St, Suite 203 City:Apex State: NC Zip: 27502 Telephone number: 919-859-0669 E-mail Address: Ivaughan(aagriwaste.com 3. Licensed Geologist(LG)(if applicable) name: 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 Lot 62 Cardiff Court, Catawba, NC. 28609 (Cardiff Glyn Subdivision) County Name: Catawba RECEIVED NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH J U N! 2 0 2023 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 Environmental Health AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 1 � r1 AOWE Common Form LHD Reference:A�I^'C o6-2023 �6 6 6. Type of facility: j 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:domestic strength wastewater from a single-family residence 8. Type and location of proposed wastewater system: Pressure Manifold 25% Reduction Chambers drain field product Location shown on site plan 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 k 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: I 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 ® NA Attestation by AOWE pursuant to G.S.130A-336.2 I,Jeff Vaughan 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 and activities determined to be engineering as determined by the North Carolina Board of Examiners for Engineers and Surveyorrsss. // , I!' June 13, 2023 Signature of Authorized On-Site Wastewater Evaluator Date Owner self-submittal of NOI: I hereby submit this NOI prepared by Print Name of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Date DHHS/EHS/OSWP—AOWE COMMON FORM Updated April 2022 Page 2 of 6 t AOWE Common Form LHD Reference: 4-U k-E—o -2 023-I 1$619 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-336.2(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: AdhiF-bG-Z°Z)- 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 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,LISPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date dCOMPLETE(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 &b31 3 via CzM 414 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/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. 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 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,USPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: 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 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) U 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 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 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,LISPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ISSUANCE OF CERTIFICATE OF OCCUPANCY: Once the LHD determines completeness based upon the ATO submission,the owner may apply to the local permitting agency for permanent electrical service to a residence,place of business or place of public assembly pursuant to G.S.130A-339. DHHS/EHS/OSWP—AOWE COMMON FORM Updated April 2022 Page 6 of 6 AGRITEC-01 GKROHL '4)R0 CERTIFICATE OF LIABILITY INSURANCE DA3/14/2023(MmIDDNYYY) 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 Connie Garkalns EL Hartsfield&Nash Agency,Inc. 10405 Ligon Mill Rd.,Ste H (A//CC,,No,,Ext):(919)556-3698 I (AIC.No):(919)556-8758 Wake Forest,NC 27587Aoss:Connie@hartsfield-nash.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of the Southeast 39926 INSURED INSURER B:ACCIDENT FUND INSURANCE COMPANY OF AMERICA 10166 Agri-Waste Technology Inc INSURER C:Evanston Insurance Company 501 N.Salem St Ste 203 INSURER D: Apex,NC 27502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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 ADDLISUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM1DD/WY)_JMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR S 2253659 1/18/2023 1/18/2024 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY LX PPa LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO S 2253659 1/18/2023 1/18/2024 BODILY INJURY(Per person) $ OWNED —SCHEDULED AUTOSRE� ONLY AUTOS SSVy p BODILY INJURYp (Per accident) $ AUTOS ONLY AUTOS ON V (Per accident)AMAGE $ $ A X UMBRELLA LIAB X OCCUR _EACH OCCURRENCE $ 2,000,000 EXCESSLIAB CLAIMS-MADE S 2253659 1/18/2023 1/18/2024 AGGREGATE $ 2,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY 100003072 1/18/2023 1/18/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N N I A 1,000,000 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Eyes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Prof&Pollution MKLV3ENV103400 8/22/2022 8/22/2023 'Each Claim 5,000,000 A Leased!Rented S 2253659 1/18/2023 1/18/2024 Equipment 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ***This is ONLY For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Contact Agency for Specific Holder info to be added **** AUTHORIZED REPRESENTATIVE I c -I(+�1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Arir ...... Engineers and Soil Scientists Agri-Waste Technology, Inc. 501 N Salem Street, Suite 203,Apex, NC 27502 " """'' $" agriwaste.com I 919.859.0669 Soil Suitability for Domestic Sewage Treatment and Disposal Systems Lot 62 Cardiff Court, Catawba,NC.28609 Cardiff Glyn Subdivision (Catawba County) PREPARED FOR: Adams Homes—AEC, LLC, Client PREPARED BY: Jeff Vaughan, Senior Agronomist& Soil Scientist Trevor Hackney,Environmental Scientist DATE: June 13, 2023 Soil suitability for domestic sewage treatment and disposal systems was evaluated on September 12, 2022, for the proposed property located at Lot 62 Cardiff Court, Catawba, NC. Jeff Vaughan and Trevor Hackney of Agri-Waste Technology, Inc. (AWT) conducted the soil evaluation. This evaluation was done to facilitate permitting for a septic system. This report and attached documents were prepared to meet the requirements for an Authorized On-Site Wastewater Evaluator to meet G.S. 130A-336.2 A drawing of the site plan, septic layout, and boring locations is included in Attachment 1. Profile descriptions for each boring are included in Attachment 2. Additional documentation about the property is included in Attachment 3. This property is a subdivision of a larger property that will make up the Cardiff Glyn subdivision. This property area is approximately 1.12 acres. The property is an open grass field. The home is proposed near the front property line and the septic system is proposed towards the back of the property. The proposed septic system is a pressure manifold septic system utilizing a 25%reduction product. Soil Suitability for Domestic Sewage Treatment and Disposal Systems The drawing in Attachment 1 details the property boundaries (as proposed by Frank Craig), soil boring locations, and layout of drain field trenches (Completed by AWT). Four soil borings were assessed on the property. Soil borings were examined to determine soil suitability for on-site sewage disposal systems in accordance with 15A 18A .1900 Rules for Sewage Treatment and Disposal Systems. These borings were 1 advanced with a hand auger. All soil borings are useable for a conventional style trench and are being utilized for the drain field area. A septic layout was performed to demonstrate available space (.1945). The layout in Attachment 1 indicates there is available space for a four-bedroom primary and repair system utilizing a 25%reduction drain field product. The proposed LTAR(Long Term Acceptance Rate) by AWT is 0.3 GPD/ft2. The soils on this property are group IV soils within the distribution and treatment zone as used to define the LTAR. Since usable slope corrected soil depths meet or exceed 32" AWT is recommending the use of the 25%reduction product. With an LTAR of 0.3 GPD/ft2, 800 linear feet of trench are necessary to support a four-bedroom home initial and repair system. The maximum trench bottom should not exceed 20". The attached drawing proves that 400 linear feet of trench can be installed for the primary septic system and 402 linear feet of trench can be installed for the repair septic system with the proposed home location on the property. Any disturbances or grading done in the usable area or within the proposed setbacks will change the potential of using the area designated for a drain field. We appreciate the opportunity to assist you in this matter. Please contact us with any questions, concerns, or comments. 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I ;1 aRR Q4 a: 11., x- a ag is 9 g a 111. a .'ga ni 31zi ill #i sugill 7 i b �t i 531 i I Ill!. i'i ;A F li lip i iil ii '11 z! s aI E $ ;;4 s s i1 i I 0 a I ! a$ la 1 1 i# Ey gg illy 11 i 4; Ili 'I l'a g pa€3tp a .1 1c a 1 'li 8 $4a 11 w �1 3a 21 iti hip II! li •r /;za7 [ �p$jaEU ipp pPs R ft pE w: �a1 Fpil E[i$ tl 511111 Y41111 1! 4 € O s3! • Septic System Design - Summary Page Project: Cardyff Glynn Date: 5/19/2023 1/ Property: 5064 Throneburg Rd ji Catawba, NC 28609 County: Catawba Engineers and Soil Scientists Subdiv.: Cardyff Glynn Agri-Waste Technology,Inc. Lot#: 62 Permit#: Project Manager: Owner: Adams Homes/Franklin Craig Jeff Vaughan, PhD, LSS Address: 3401 St.Vardell Lane,Suite B; Type of System: III bg jvaughan@agriwaste.com Charlotte, NC 28217 919-859-0669 Phone: 704-558-4527 Engineer: Email: bcashion@adamshomes.com PIN: 378003016801 Rodney L. Huffman, PhD, PE rhuffman@agriwaste.com EHS: Soil Parameters Soil Evaluation By: Special Conditions/Notes: LIAR: 0.30 gpd/ft2 Design Parameters Type of Establishment: Residence, 5 or fewer bedrooms Unit: Bedroom #of Units: 4 Septic Tank Specifications Min.Tank Capacity: 1,000 gal Exterior Interior Actual Tank Volume: 1,250 gal Length: 125.5 119.5 in. Tank Manufacturer: Shoaf Width: 65.5 59.5 in. Tank Model: TS 1250 STB Depth: 62.0 54.5 in. Primary Draintield Specitications Type of Distribution: Parallel Pressure Manifold Trench Bottom Area: 1600 ft2 Trench Media: Chambers Minimum Drain Line: 400 ft Trench Width: 3 ft Actual Drain Line: 400 ft Trench Depth: in. Number of Lines: 4 (or as specified on permit) Minimum Line Spacing: 9 ft O.C. Wastewater Treatment System Design Calculations Project: Cardyff Glynn Location: 5064 Throneburg Rd Catawba, NC 28609 County: Catawba Septic Tank Sizing Daily Flow Estimate: Unit #of Units Flow/Unit Flow/Day Bedroom 4 120 480 0 0 C1= 480 gpd Septic Tank Minimum Capacity: Per NCAC T15A:18A.1952(b)(1): For individual residences with 4 bedrooms, Minimum Liquid Capacity (V)= 1,000 gal Septic Tank Specs: Manufacturer: Shoaf Model: TS 1250 STB Volume: 1,250 gal Weight: 11,000 lbs Exterior Interior Length: 125.5 119.5 in. Width: 65.5 59.5 in. Depth: 62.0 54.5 in. Shape of Risers: Circular Diameter: 2,00 ft • Pump Tank Storage & Float Settings Project: Cardyff Glynn Location: 5064 Throneburg Rd Catawba, NC 28609 County: Catawba Tank Manufacturer Shoaf Tank Model TS 1275 PT Interior Height (in.) 60.5 in. Avg. Storage 21.07 gal/in. Primary System Elevations, measured from bottom towards top (0= Interior Bottom of Tank): Top of pump (including 4" block) 16.1 in. (Pump height = 12 1/8") Pump Off 18.0 in. Pump On 26.5 in. (set for dose volume) Alarm On 32.5 in. (6 in. above On Float) Emergency Storage Available Pump Tank 590 gal Days of Storage 1.23 days (determined from"interior top of tank"-"High Water Alarm") Repair System Elevations, measured from bottom towards top(0= Interior Bottom of Tank): Top of pump (including 4" block) 16.1 in. (Pump height= 12 1/8") Pump Off 18.0 in. Pump On 26.5 in. (set for dose volume) Alarm On 32.5 in. (6 in. above On Float) Emergency Storage Available Pump Tank 590 gal Days of Storage 1.23 days (determined from"interior top of tank"-"High Water Alarm") 1 ELEVATIONS Project: Cardyff Glynn Location: 5064 Throneburg Rd Catawba,NC 28609 County: Catawba Benchmark Iron pin(pc)SE corner Lot 63 BM Elev 999.93 ft Septic Tank 1,250 gal Ground Surface i! ` *ft Depth of Soil Cover 12 In. 1.00 ft Overall Ht of Tank 61.5 in. 5.13 ft Elev,Base of Tank 983.69 ft Ht to 4"Inlet Invert 50 in. 4.17 ft Elev,4"Inlet Invert 987.85 ft Ht to 4"Outlet Invert 48 in. 4.00 ft Elev,4"Outlet Invert 987.69 ft Gravel Basel _ 61 in. 0.50 ft Elev,Bot of Excavation 983.19 ft Pump Tank 1275 gal Ground Surface 989.60 ft Depth of Soil Cover 14 in. • 1.17 ft Overall Ht of Tank 67.5 in. 5.63 ft Elev,Base of Tank 982.81 ft Ht to 4"Inlet Invert 54.5 in. 4.54 ft Elev,4"Inlet Invert 987.35 ft Ht to 2"Outlet Invert 58 in. 4.83 ft Elev,2"Outlet Invert 987.64 ft Gravel Base in. 0.50 ft Elev,Bot of Excavation 982.31 ft ST Inlet Pipe _ Grade @ Stub-out 990.09 ft Depth of Stub-out,top 1.5 ft Elev,Stub-out Invert 988.24 ft Elev @ ST Inlet Invert 987.85 ft Length 15 ft Slope 2.6 % Pipe,ST to PT ID 4 in. 0.33 ft OD L 4.5 in. 0.38 ft Elev,ST Outlet Invert 987.69 ft Elev,PT Inlet Invert 987.35 ft Length [ 11.21ft Slope 3.0% Cover over inlet pipe 1.60 ft Pump Reqmt. Floor Thickness 4 in. 0.33 ft Elev,Pump Tank Floor 983.14 ft Pump Block Ht. 4 in. 0.33 ft Elev,Pump Intake 983.48 ft Grade @ Primary Manifold 994.9 ft Grade @ Repair Manifold 998.2 ft Min.Covert_ in. 1.50 ft Max Elev,Primary 993.40 ft Max Elev,Repair 996.70 ft Elev Diff,Primary 9.92 ft Elev Diff,Repair 13.22 ft Drainfield Design Project Cardyff Glynn Location 5064 Throneburg Rd Catawba,NC 28609 County Catawba Drainfield Sizing Primary LIAR 0.3 gpd/ft2 Daily Design Flow 480 gpd Type of Drainfield Media Chambers Req.Drainfield Area 1,600 ft2 Required Drainline Trench Width,Eff. 3 ft After 25%Reduction 400 ft Required Drainline 533 ft Minimum Line Spacing 9 ft(O.C.) Repair LIAR 0.3 gpd/ft2 Daily Design Flow 480 gpd Type of Drainfield Media Chambers Req.Drainfield Area 1,600 ft2 Required Drainline Trench Width,Eff. 3 ft After 25%Reduction 400 ft Required Drainline 533 ft Minimum Line Spacing 9 ft(O.C.) Drainfield Layout Elevation tine Length Used as Used as Line Use Flag Color (ft) (ft) Primary(ft) Repair(ft) 1 Layout Line red 998.6 15 2 Layout Line pink 997.9 39 3 Layout Line blue 997.4 111 98.0 4 Layout Line purple 993.4 137 130.0 5 Layout Line white 996.9 174 174.0 6 Layout Line pink 994.1 176 154.0 7 Layout Line blue 993.1 114 82.0 8 Layout Line yellow 992.7 87 82.0 9 Layout Line purple I 990.9 90 82.0 Total 943 400 402 Count 9 4 3 Note:Line length totals are shown to the nearest foot. For Chambers or Low-profile Chambers: Effective trench lengths are shown.Add 1'for total installation length. PRESSURE MANIFOLD DESIGN (Primary) Site Information Project: Cardyff Glynn Location: 5064 Throneburg Rd Catawba,NC 28609 County: Catawba Design Information Estimated Daily Flow 480 gal/day L.T.A.R.(from Catawba Co.) 0.3 gal/day/ft2 L.T.A.R.+5% 0.315 gal/day/ft2 Trench Width 3 ft. Line Length Required 533 ft. Length after 25%Reduction 400 ft L.T.A.R.Reduced 0.400 gal/day/ft2 L.T.A.R.Reduced+5% 0.420 gal/day/ft2 DRAINFIELD INFO.- Primary Proposed Type of System/Distribution: Pump to Pressure Manifold using Chambers Flag Line Flow Flow/Foot Line Line No. Color Length(ft) Tap (gpm) (gpm/ft) , L.T.A.R. 6 pink 154 3/4in SCH 80 10.10 0.066 0.395 7 blue 82 1/2in SCH 80 5.48 0.067 0.403 8 yellow 82 1/2in SCH 80 5.48 0.067 0.403 9 purple 82 1/2in SCH 80 5.48 0.067 0.403 Total 400 Total 26.54 Avg. 0.401 Note:Line lengths are calculated in 4'increments to reflect use of Chambers product.2'added for endcaps. Total Run Time 18.09 min. Drainfield Capacity 261.2 gal of Drainfield Cap 68.6% (Req.Range 66-75%) Dose Volume 179.2 gal/dose Run Time/Dose 6.8 minutes Range 5-7 minutes unless uphill,checked Volume/depth 21.07 gal/in. (Per tank manufacturer's specifications) Estimated Drawdown 8.50 in. Manifold Box Number of Taps 4 with L_ 0 Split(s) Manifold Length 3.5 ft. (approximate) PRESSURE MANIFOLD SYSTEM DESIGN (Repair) Site Information Project: Cardyff Glynn Location: 5064 Throneburg Rd Catawba,NC 28609 County: Catawba Design Information Estimated Daily Flow 480 gal/day L.T.A.R.(from Catawba Co.) 0.3 gal/day/ft2 L.T.A.R.+5% 0.315 gal/day/ft2 Trench Width 3 ft. Line Length Required 533 ft. Length after 25%Reduction 400 ft L.T.A.R.Reduced 0.400 gal/day/ft2 L.T.A.R.Reduced+5% 0.420 gal/day/ft2 DRAINFIELD INFO.- Repair Proposed Type of System/Distribution:[Pump to Pressure Manifold using Chambers Flag Line Flow Flow/Foot Line Line No. Color Length(ft.) (gpm) (gpm/ft) L.T.A.R. 3 blue 98 1/2in SCH 80 5.48 0.056 0.394 4 purple 130 1/2in SCH 40 7.11 0.055 0.386 5 white 174 314in SCH 80 10.10 0.058 0.409 Total 402 Total 22.69 Avg. 0.396 Note:Line lengths are calculated in 4'increments to reflect use of Chambers product.2'added for endcaps. Total Run Time 21.15 min. Drainfield Capacity 262.5 gal %of Drainfield Cap 68.2% (Req. Range 66-75%) Dose Volume 179.0 gal/dose Run Time/Dose 7.9 minutes Range 5-7 minutes unless uphill,checked Volume/depth 21.07 gal/in. (Per tank manufacturer's specifications) Estimated Drawdown 8.50 in. Manifold Box Number of Taps 3l with[ 0 Split(s) Manifold Length 3.0 ft. (approximate) • • PUMP DESIGN System(initial/repair): Primary Project: Cardyff Glynn Location: 5064 Throneburg Rd Catawba,NC 28609 County: Catawba Friction Losses _ Suction Head 0 ft (submersible 0) Elev.Difference(highest point from pump) _ 9.92 ft Design Pressure At Outlet 2Jft Supply Line-1.5"Schedule 40 PVC Pipe Diameter,Nominal' 1Jin. Pipe Diameter(ID) 1.59 in. Flow 26.54 gpm Pipe Length[ 178Ift Velocity 4.29 ft/sec Pipe Length for Fittings 17.8 ft Meets requirement that 2 ft/s<v<5 ft/s. Equivalent Length 195.8 ft Estimated Friction Loss in Supply Line 8.72 ft Pressure Filter Friction Loss 0.411ft (from manufacturer) Friction Loss-Taps/Special Fittings 3.5 ft TOTAL 24.55 ft. Flow for Anti-Siphon Hole Hole Diameters 3/16 in. Hole Flowrate 2.05 gpm Pump Efficiency 0.7 (assumed,typical) Motor Efficiency 0.9 (assumed for electric pumps) Flow 28.59 gpm Required Horsepower 0.28 hp TDH 24.55 ft Pump Selection Manufacturer: Zoeller__ Model:L_N152 Horsepower: 0.4 PUMP PERFORMANCE CURVE MODEL 151/152/153 so- id- 45 150 12- 40 !1 10- 152 � ttB- 25 151 • 44. ingFulnl . '' \ 15 4- 10 2- 5 0 10 20 00 40 50 80 70 80 SO 100 GALLONS LITERS 4p 80 17i0 160 2!'10 210 240 020 3Bo FLOW PER MINUTE clam L PUMP DESIGN System(initial/repair): Repair Project: Cardyff Glynn Location: 5064 Throne burg Rd Catawba,NC 28609 County: Catawba Friction Losses Suction Head 0 ft (submersible O) Elev.Difference(highest point from pump) 13.22 ft Design Pressure At Outlet 2 ft Supply Line-2.0"Schedule 40 PVC Pipe Diameter.Nominal 1.5 in. Pipe Diameter(ID) 1.59 in. Flow 22.69 gpm Pipe Length 237 ft Velocity 3.67 ft/s Pipe Length for Fittings 23.7 ft Meets requirement that 2 Ws<v<5 ft/s. Equivalent Length 260.7 ft Estimated Friction Loss in Supply Line 8.68 ft Pressure Filter Friction Loss 0.23 ft (from manufacturer) Friction Loss-Taps/Special Fittings 3.5 ft TOTAL 27.64 ft. Flow for Anti-Siphon Hole Hole Diameter 3/16 in. Hole Flowrate 2.18 gpm Pump Efficiency 0.7 (assumed,typical) Motor Efficiency 0.9 (assumed for electric pumps) Flow 24.87 gpm Required Horsepower 0.28 hp TDH 27.64 ft. Pump Selection Manufacturer: Zoeller Model: N152 JI Horsepower: 0.4 PUMP PERFORMANCE CURVE MODEL 151/152/153 50. 14- 45 153 12- 40 35 1\ 10- V. 30 a- 25 151 rat ng... g 20 15 - 10- 2- 5 0 10 20 30 40 50 k 70 g0 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 01”011 Attachment 2: Soil Boring Description Sheets • COUNTY:Catawba Co._ SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) CLIENT: Adams Homes APPLICATION DATE ADDRESS: Lot 62 Cardiff Court.Catawba,NC 28609 DATE EVALUATED: 8/09/22 PROPOSED FACILITY: Single Family Residence PROPOSED DESIGN FLOW(.1949): 480 GPD PROPERTY SIZE: 1.12 ac. LOCATION OF SITE:Lot 62 Cardiff Court.Catawba,NC 28609 PROPERTY RECORDED: WATER SUPPLY: ❑Private XPublic ❑ Well ❑ Spring ❑Other EVALUATION METHOD: X Mier Boring ❑Pit ❑Cut TYPE OF WASTEWATER: X Sewage ❑Industrial Process ❑Mixed P SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS .1940 LANDSCAPE HORIZON E POSITION/ DEPTH 1942 PROFILE # SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPR RESTR <AR TEXTURE MINERALOGY COLOR DEPTH 0 HORIZ CLASS 0-15" SCL;GR SS;SP;FR - 36" - Provisionally 9% Suitable 15-36" C;SBK SS;SP;Fl SB 0.3 0-10" SCL;GR SS;SP;FR 36' - - 8% Provisionally SB 10-36" C;SBK SS;SP;Fl Suitable 0.3 • 0-12" SCL;GR SS;SP;FR 16` Provisionally 7a/o Suitable SB 12-36" C;SBK SS;SP;FI • 3 0.3 • SB 0-8" SCL;GR SS;SP;FR +6' Provisionally 4 6% 8-36" Suitable C;SBK SS;SP;FI 0.3 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): SITE CLASSIFICATION(.1948): Available Space(.1945) Provisionally Provisionally Suitable Suitable EVALUATED BY: Jeff Vaughan y OTHER(S)PRESENT: Trevor Hackney System Type(s)e(s) Aga/0 Reduction 25% Reduction Pressure Manifold Pressure Manifold Site LTAR 0.3 GPD/Ft2 0.3 GPD/Ft2 COMMENTS Updated February 2014 LEGEND use the ollowin: standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.8 0.6-0.4 SEXP(Slightly Expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) EXP(Expansive) M(Massive) D(Drainage Way) CR(Crumb) DS(Debris Slump) II SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Foot Slope) ABK(Angular Blocky) H(Head Slope) III Si(Silt) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) SiCL(Silty Clay Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SCL(Sandy Clay Loam) MOIST WET S(Shoulder Slope) SiL(Silt Loam) T(Terrace) VFR(Very Friable) NS(Non-sticky) TV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SiC(Silty Clay) FI(Finn) S(Sticky) C(Clay) VFI(Very Finn v.Very Sticky) VS(Very Sticky) 0(Organic) None None EFI(Extremely Firm) NP(Non-plastic) SP(Slightly Plastic) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROLITE S(suitable)or U(unsuitable) SOIL WETNESS Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of saprolite shall be by pits. Long-term Acceptance Rate(LTAR):gal/day/ft2 Show profile locations and other site features(dimensions,reference or benchmark,and North). 1 [ 1 g.iiil - is 1 II _ _________ 1 ----- • a - a In __ ____. 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