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HomeMy WebLinkAboutAOWE-06-2023-198829.tif Residential Subsurface Wastewater Treatment and Disposal System AOWE ATO for Lot 4 - Spring Farms 5216 Hall Street Conover, NC 28613 Tax Parcel Number: 373411751261 October 10, 2023 Prepared for: y SOIL ' o;c 11 OAa Century Complete ." ' ,!,a '' ; 0 9325 Center Lake Dr., Suite 160 /f � "`"•'+ Charlotte, NC 28216 �f1J`•� � �lJ-1 704-488-1100 Cle co, Atielo Prepared by: Larry Thompson, REHS, LSS Thompson Environmental Consulting, Inc. PO Box 541 � Ceron A Midland, NC 28107-0541 • �a�BE Phone: 704-301-4881 - •. • •N Larry@thompsonenv.com f, .1. ‘• 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). The system has been installed by Dewey Grant(Level II Installer 2607) and inspected by TEC. The system has been installed in general accordance with the AOWE permit package submitted to your office. The recommended maintenance plan and as-built drawing are included in this package. This report shall allow the Authorization to Operate to be issued for the certificate of occupancy for the above referenced facility. OPERATION and MAINTENANCE A. Operation and Maintenance 1. The septic tank and pump tank shall be pumped out when the solids within the septic tank reach an elevation that is equivalent to 25% of the volume of the tank. In some situations, the tanks may need to be pumped more frequently; for example, if you are using a garbage disposal, it is recommended that the septic and pump tanks be cleaned out annually. 2. The effluent filter should be inspected annually. When it becomes necessary to clean the effluent filter, the filter should be removed, and the accumulated debris washed back into the septic—not onto the lawn. 3. The drainfield area should be maintained to prevent overgrowth of vegetation. Any damp areas, leakages or malfunctions should be addressed immediately. 4. Divert gutter downspouts and surface water runoff away from the septic and pump tanks. 5. Valve boxes and pressure manifold boxes should be inspected annually for proper function. The pressure head should checked to ensure the system is dosing properly. B. Suggestions to the Homeowner 1. As previously mentioned, a garbage disposal is not recommended. The ground up garbage adds large amounts of solids into a septic tank that tend to degrade at a very slow rate. 2. Grease, cooking oils, coffee grounds and non-degradable solids (disposable diapers, cigarettes and solid paper wastes) should never be put into a septic tank. 3. Used motor oil or any oily liquids should not be disposed of in a septic tank. 4. Be aware of the amount of water that you are using in your home. Water saving fixtures and devices can be installed on sinks, toilets and showers to reduce the volume of wastewater that you are sending to your drain field. 5. Run dishwashers and washing machines only when you have a full load. 6. Repair leaky faucets and toilets. Small drips equal large volumes of water over time and can over burden your drain field. 7. Do not use chemical additives in your system. Studies have indicated that they do not increase the biological activity that naturally occurs in the septic system and in some cases certain additives have been found to be detrimental to the life of a system. ID lLrM5 US}5pY � 14 ilg Pi(' i " Li 0 i 141 v `S5' Pee. ,a s5 Try 9 5'S s- Q e sv.N'i s 5$, Pep, 55'ec k- a--, la' --.°-_ I. � ' r- --- ' , ,; a it 0' .... .......,,,,... Ki,, ,,,,! 1 . . . . -y • r't:' i3v3y 1`A' \g, i LIS \r1 %1,rL 1 v 1 .._- 15' I-Act_ ( ( '‘ r-r.e 4 September 30, 2023 Subject: Septic System Installation Spring Farms Subdivision Lots 1, 2, 3,4, 5, and 6 Conover, NC 28613 The septic systems installed for the above-referenced properties were specified by Larry Thompson, LSS, with the final installation work being performed by Dewey Grant. Mr.Thompson has shared his closeout package with us and we do hereby accept the septic system installed for Lot 1 (1270 Elgin Drive), Lot 2 (1274 Elgin Drive), and Lot 3 (5210 Hall Street), Lot 4 (5216 Hall Street, Lot 5 (5222 Hall Street, and Lot 6(5228 Hall Street), Spring Farms, Conover. Sincere), ,fir Katie Dyess(Sep 30,2023 22:32 EDT) Century Complete 9325 Center Lake Dr.,Suite 160 Charlotte, NC 28216 September 30, 2023 RE: Septic System Installation Spring Farms Subdivision Lots 1, 2, 3, 4, 5, and 6 Conover, NC 28613 The purpose of this letter is to confirm that the septic system installations for Lots 1, 2, 3, 4, 5, and 6—Spring Farms were installed in general accordance with the proposals submitted to your office by Larry Thompson, LSS. Sincerely, Dewey L Grant(Sep 30,2023 20:03 EDT) Dewey Grant Maiden Grading and Septic Tank 6P►g•t•)0)3 gq?03 „u STATEo,N ROY COOPER•Governor Alt V 1/ —b 6_20 — 1�o 2-/ *"s NC DEPARTMENT OF KODY H. KINSLEY• Secretary HEALTH AND HUMAN SERVICES r HELEN WOLSTENHOLME •Interim Deputy Secretary for Health a,,. 9, »•n�» '� 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: �21-23 by irc) 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: WA 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 RECEIVED NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH J U N 2 1 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 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Environmental Health a AOWE Common Form LHD Reference: J'0I -0 I^2023- rd P-i 6. Type of facility: ❑� Place of residence No. Bedrooms: 4 No.Occupants:8 ❑ Place of business Basis for flow calculation: ❑ Place of public assembly Basis for flow calculation: 7. Factors that would affect the wastewater load: Proposal is for domestic wastewater strength only. 8. Type and location of proposed wastewater system: Gravity-flow accepted system located behind the residence. System classification Type Illg. 9. Design wastewater flow: 480 gpd Design wastewater strength: domestic ❑ high strength ❑ industrial process(For high strength and industrial process wastewater,a Professional Engineer licensed in accordance with G.S.89C shall design the on-site wastewater system.) 10. A plat as defined in G.S. 130A-334(7a)is attached: E 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 E No This is a saprolite system. ❑Yes El No 12. Evaluation(s)of soil conditions and site features in accordance with G.5. 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 n 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 activities determined to be engineering as determined by the North Carolina Board of Examiners for Errr'i'r s a -' urveyors. • �.._ 06-20-23 Signature of f hori ed.6Site Wastewater aluator Date r' weer self-submittal of NOI: 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 AOWE Common Form LHD Reference: D -262 3 --(18 2/ 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 IG.S.130A-336.2(f)J RIGHT OF ENTRY: The submittal of this Notice of Intent to Construct grants right of entry to the Local Health Department and the State to the referenced property. ISSUANCE OF BUILDING PERMIT: Once the 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 p AOWE Common Form LHD Reference: >� -p6-2a23 �/cf Zq 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 Date [r 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 cY AI)3 via 12- I Date Email,FAX,USPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered j�-+r`bi� peer f —26^23 Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Dote DHHS/EHS/05WP—AOWE COMMON FORM Updated April2022 Page 4 of 6 AOWE Common Form LHD Reference: Re-submittal of NOI with missing items included This Section is for use by owner to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the AOWE. LHD USE ONLY: This NOI resubmittal received: by Date Initials Item#from initial NOI Resubmittal description • Attestation by AOWE certified in North Carolina pursuant to G.S. 130A-336.2 I, hereby attest that the information required to be included with Authorized On-Site Wastewater Evaluator(Print 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 Date Email,FAX,USPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHHS/EHS/OSWP-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) ❑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 Date Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ISSUANCE OF CERTIFICATE OF OCCUPANCY: Once the LHD determines completeness based upon the ATO submission,the owner may apply to the local permitting agency for permanent electrical service to a residence,place of business or place of public assembly pursuant to G.S.130A-339. DHNS/ENS/OSWP—AOWE COMMON FORM Updated April 2022 Page 6 of 6 AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 1-1 3 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: 0.p SOIL sc., Century Complete ,; .°�; 9325 Center Lake Dr., Suite 160 ,� f L# + ', • Charlotte, NC 28216 �� �, 704-488-1100 ''"�'"� 1za7cleNORni� Prepared by: _At VIA a Larry Thompson, REHS, LSS Thompson Environmental Consulting, Inc. �' .■' `■, PO Box 541 „ oft Midland, NC 28107-0541 ' 4.) jr ber Phone: 704-301-4881 ' 0016E r ■ r eft a larry@thompsonenv.com w4:a i rrrrra rrrar 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 1 SA 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 I. 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 DATE(MM/DD/VYYY) ACORD 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: Davie Vaughan Higginbotham Insurance Agency, Inc. PHONE FAX 500 W. 13th Street _1AIC.No.Ext):9187797880 (Arc,No):817-882-9284 Fort Worth TX 76102 E-MAIL dlvjrr higginbotham.net INSURER(S)AFFORDING COVERAGE NAIC# License#:2081754 INSURER A:Mid-Continent Casualty Company 23418 INSURED THOMENV-01 INSURER B:Hartford Underwriters Insurance Company 30104 Thompson Environmental Consulting, Inc. PO Box 541 INSURERC: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM1DD/YYYY) LIMITS A X COMMERCIALGENERALLIABILITY 04-GL-001086672 9/25/2022 9/25/2023 EACH OCCURRENCE $1,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES(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 JEC7 LOC PRODUCTS-COMP/OPAGG $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 $ BED RETENTION$ $ B WORKERS COMPENSATION 38VVECNW6175 10/17/2022 10/17/2023 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N N 1 A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? (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/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 55 ` fD Lt 1 " LID IP ss, pip 1 „ tea' •zo. �' 0 1✓1 9 1 WO 3Cd Sept)C. .iet x. -- ► + 3x57 1' L v _ 15 kcdl eS) -r-c- ( Thompson Environmental Consulting,Inc, She j'� of PO Box 541 PROPERTY ID it: ��T: F 1 Midland,NC 28107 COUNT& big" SOIL/SITE EVALUATION for ON-S5J.E WASTEWATERS YTEM OWNER: 501111(a � 44_ y ADDRESS: JJ DATE EVALUATED: � PROPOSED FACILITY: _PROPOSED DESIG FLp 949): PROPERTY SIZE: LOCATION OF SITE: 5-&E(.i' J PROPERTY RECORDED: WATER SUPPLY: 0 Private !3 i'ublic ❑Well O Spring El Other EVALUATION METHOD: u:er Boring ❑Pit D Cut TYPE OF WASTEWATER: (I.8'ewage 0 Industrial Process 0 Mixed • • • • P R SOIL MORPHOLOGY OTHER x (.1941) PROFILE FACTORS 1 .1940 E LANDSCAPE HORIZON POSITION/ DEPTH 1942 PROFILE it SLOPE% (IN-) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUC'I ORE! CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR &LTAR TEXTURE ,i111NERALOGY COLOR DEPTH CLASS HORIZ .19'Ali 1 c 57 �, c")5 1 L �� 0. 3 O- Uf Sc: : -{` .- s 7 _ ms. L q 2 cai D . -3 . L /9 . �- - ? ) ?S 4,,ci-- 4 141 (D (- DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): e • SITE CLASSIFICATION(.1948): prowls!r+'! 1 P / Available Space(.1945) PS PS ! ',� 0• A EVALUATED BY: b t.•4. A �r; S T. System Type(s) Accepted PPBPS OTHER(S)PRESENT: 10, - . "�4 . i Site LTAR 0.3 0.3 L. Thompson, LSS F ., '"�� COMMENTS: ._ ,Gr Updated February 2014 / J • • 1/uick4M STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) 12" El mat- '��8 �= �=a1� Ii1i ® 34" SIDE VIEW SECTION VIEW MultiPort End Cap L 16" 12" 4! • - 11.1.111.111��k _��11 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 (a)The structural integrity of each chamber,end plate.wedge end other accessory manufactured by Infiltrator("Units'),when instated and operated in a leachfield of an onsite septic system in accordance with Infiltrator's nsWetlons,Is warranted to the original purchaser("Holder")against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units;prodded,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 exercise its warranty rights,Holder must e er in Units writing at its Corporate Headquertem OldSaybrook,Connecticut within ly (15) N FI LTRATO days of the aleged defect.infiltrator Mil supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. infitrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE UMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE OCCLUSIVE.THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS,INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. SYSTEMS I N C (c)This Limited Warranty shall be void If any part of the chamber system is manufactured by anyone other than Infiltrator.The Limited Warranty does not extend to incidental,consequential.special or indirect damages.Infiltrator shall not be liable for penalties or liquidated damages,including loss of Environmental Onsite Wastewater Solutions?' production end profits,labor and materials.overhead costs,or other losses or expenses Incurred by the Holler or any third party.Specifically excluded tram limped Warranty coverage am damage to the Units die to ordinary wear and tear,alteration,accident,misuse,abuse or neglect of the Units;the Units being subjected to vehicle traffic or other condttlons which are not permitted by the nstelatlon instructions;I%Num to maintain the 6 Business Park Road • P O. Box 768 minimum ground covers set forth in the Inoteletion nstrucUens:the placement of improper materials Into the system containing the Units;failure of the Units or the septic system due to Improper siting or improper sizing,excessive water usage,Improper grease disposal.or improper operation;or Old Saybrook, CT 06475 any other N event not caused by Infiltrator This Limited Warranty shall be void it the Holder fells to comply with all of the terms set forth In this Limited 860-577-7000•FAX 860-577-7001 Further.In no event shah Infiltrator be responsible for any loss or damage to the Holder,the Units.or any third party resulting from Instatatfon or ship- 800_221_4436 sent,or from any product liability claims of Holder or any third party. For this Limited Warranty to apply,the Units must be installed in accordance G L lJ with all site conditions required by state and local codes;ell other applicable laws;end Infiltrators Installation Instructions. (el)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any parry other than Me origi- nal Holder. The above represents the Standard Limited Warrenly offered by Infiltrator A limited number of states and counties have different warranty require- ments.Any purchaser of Units should contact Infiltrators Corporate Headquarters In Old Saybrook,Connecticut,prior to such purchase,to obtain a copy of the applicable warranty,end should carefully reed that warranty prior to the purchase of Units. U.S.Patents:4,759,861;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 •• Canadian Patents:1,329,959;2,004,564 Other patents pending. , Infiltrator,Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark in France.Infiltrator Systems Inc. is a registered trademark in Mexico.Contour,Contour Swivel Connection,MicroLeaching,PolyTuff,SnapLock,ChamberSpacer,PosiLock,QuickCut,QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc.®2003 Infiltrator Systems Inc.Printed In U.S.A. Q011203HP-0 •eve ••ea Id- ° m ,e a Flood Hazard Area Certificate halloDom Rd Amway to mapping Federalr provAled by the Federal Rngeacy management agave d / she.an the ORRd need Maresca Rote Map(an0lr)Panel J7J4.Coked" Canty Nerd Crdha elleethm*tee September 5,11007.Nopropertyin property te hereon h not located within•sword good hazard area the property Is.atheM w e Q R� \lb A� r/lnh to 0 doMpn td'tone X-other awe'.Woos a'alrmhe to be weeks �� $ W'' Ft. I�: Clint.Nadal.:arwe make Alfvn modal.,IX onnud e / Watershed Certificate: snr re ly awe m my eknoiegr lax rot dew not eh wets v watt ://4 oting Ado eu�yw wf.danM a'�!M as Oy the oa.ona m lb.bbr.nnairoiwrxnEl (._pNp of Cofarta Counts North Crdha Environmento!Health Approval of Subdivision Plat •Tx 1mal plot and Ou shown Mve been approvd by the Environmental Mealth Metal.Of the Catawba Connlls 1' e Department of Pubik Health, y��1•,,/ 0 "APLZ \eficlr / Vicinity Dap (MS) QW, Notice Environmental Health Supervisor or Designee Cots SR' /.e� fit a irrondw a and•eel y w the y ea+smen nghf of nay en neon( '�, wd all rrvey I la and nghu or way �pD1�� w.� ♦ ® •TN,survey a wDM to any foots NM may be disclosed by o - ♦d �i' �aJ 'Qo• � NO and occwot•UBe egret. • pA / e3dp Approval Certificate for et:" /:•• `Su Major Subdivision Plat •Tx survey plot do•,net,now o y wr.•rb.d•written or PI ! • T unwritten weemeets.dadkatrons r other mcumbranna&Kb .t•� This find plat odd the aereef names shown brews could evbf an NM properly wd not upper w this grid! Nan-dame easement ` .n' �p �i r}ryj`Q .y 'kV ?.y g have been found to campy MIA tin AccordMyy users of tax plot cur wand to remota Meet M In• tong the RAY Wm m \LMT �. �+t}e SubdNsrn R000Mbene of Colombo count' grist..of such unrecorded burden not shown hereon. Springs Road on lot r /w' �1)f•\ 'R"b end wen approved by the Catawba Count' ♦ Dnnw•y '�• Planning ONecror r Ns/h•r designee.Aa •T•Global NON dean Satellite System Ov d �' feadmem `s 1 \-8,,Ig streets,ORIN end donor required 01 N ( an wog Por to varfam fe geepollaf perrlknhp aaeureayy tendaro&port 1 �I; 4i• V,p *N991.merits haw Men M1N*91 acsoMMO *tandem tr gedetx netrorka at the 9SX ewffdwn accuracy#tt / to r ecifcarwns and standard.,r a P ro:Mxclen(95X confidence)using red lime kb...ft. Tor l0'.70' w f' d N guarantee of fin Installation of the folkway Information was used Sy11 Man. �` . $} punted improvements In on amount and g *�e♦� N NG i�} * manor so/0.Po'to OM...Ceun�Ma LTd Benbow toddy that mi.mop wasmown undr my �� ♦ �• W, C�. OW nceNvd Txpeel le approved r suprvision H"m on actual CPS rY moW undr mr Now-Mkn r E tWI. '+ u 0 '.'o . recording in tin OM.oo of the,olo(r al and the folk,k ♦ ��. %• `4 w a �i' Dew of Catawba County ON soy(fro) g hfrmotbn we*use fp won,'Ne wrwy �, a• v� W, '�. ` Maya r ea of Mx pose of Srwy CLASS AA p 1'led Ii - e� N W -Ig. WN 4 ei j m /�/.1/n. ,/.y 9////>3 Lek jdCiAs ermdyPh"Le:grit e S. W.a e O 'ijb ® - 'Nnefr el Pronn,NI6(r aspnao Dates of Sr m 12/1/2021-8/8/2021 • 1 `h n1 Q'Qr y . .5 gp r Dotum/fpoa:SNOW(2011) Al' v `e, 'a e a` 3 PublxDdfrl d-Confral Lbw vies 1 • v+\3. ®a�'j 45••���0 Con,b Ydak lots + s. a Ao Combined Dew Facto*09998107e \f „.t�, 91, ��nr' NW*US Survey Foot 11 r'�,-a tj® r��'� ♦ ,,tee -a' e Area defmmMd by coordinate computations. 1 1 L S e al ,• - 1f'. •No NOS r NCO'Hon&Casket MGna"wt found MOW 1.000 .a 2 t Cloyel H. Probst, Jr. Todd' 1 .,,e • Met of tree site. ! e ,3f • w Ea • Coterins E. Props! 1 v- p •(1- dal `�j add°13 C Judy P. Stevens •Lot(+)to be served by ally water and individual epee& 7 0g6' • al rO 50 10I leiah Mn P. B(odyef! 1`, 9 j3.E 392• E! a. 1788, Pt'. 1 f05 •Property Ixs within prusenfty of an°grkufruni district. '1.00 •N 7S0 a yb•q •UMW.re underground 1116s.,S% �• Total • =75 Note! •Rd mepfe,tress planted no moot Mon 50 feat writhe)No in R/'R 333''� Contour linos ore scaled from right-of-way and comply with N000r w0alalrw guidelines. yl Z rt Il •ng�j3.Oo I3 3tb. Catawba CIS webslte. •Tre x ne 10'mahage and urerty eaaemsnt along all cat linos. ' • _ Total numb*of loft N 'ice , �..a ,.,I e COy Ornrrry ~ fl!-, Otot Qy I Id CO.embow,crrrrr that this alp was Grown under my 1l >1-°�.Eats a 0A3 pM•31,5•47rTe V P arpenteron from a,actual survey made wer my suporvuron M E (deed deetnpfkn madded 1,Book 17JR Par 7e2) Tat this Oro.. 1 �,lee Nor�3.pp'13• . ,3 0 l e plot w prepared h occrdonae•th as a7-Jo es amwdea 7"1 1 av ® '4 mot Ibis plate m«N Me rpuMrwt of OS a7-JCL t Nether 1 + M a certify that oatea,Nin,ty Newly Met nog dnoaldlwiadnnl IAef a SD.` a' • p0, .:1,rreol�haN M R45.To1o1 " Sr regulates varcme of land OmIrV.%1/SEae°w,wt 6ve,0110�3•E 297'sy e Q \ Witness this my rlghm rlgnotun,r'plsfrol/on numb*and a =t N 73' ® w • y i m NM 19 of August 1012 A.D. o_ i l letel oh p0, N InAV.Total •4 FF�• ..•'�,'�i;..ic:1!dC3`'•n,� e 173 p0'.o;E 279. rTkdm uc&Moense e CVC PL-S-L-3r7.S It? 551•`• rt� \1 a N r L-3175-1588 taw-a«.r.easement along the RAI R,e el , 1 `_ b 1 I IC' ''.1•}7••$ t1.410. q• Hall Street on Lot 1 1•'.•• Including 0.21 Acre In R/W Eoenn=nYI •:'P�:.'. •. }! hoclottinlese otherwise dlot000 all oomed corn an• le'ACP Dorf orp• haxwld proved O.ground To ewes!to grin 1 Somment distance.multiply the grand&Mance by the I ` '1 1 Wolof vaA'es � RCP , eonbad/aafr. 1A;/1 Eve I _ �i . Review Officer Certificate Er �!S 86"JO JJ .. State of North Canino t r- as tp - --`- County of Catawba S.R. f513 Legend R/w E7 In Drive `\ d �11411acall Rmiew Officer for Carawbe g 1 �p'you P.B. 60.Fg. ,�v.sss }; County aeay that the mop r prof to ankh Mx erfi Callon x CAPS ON MONUMENTS SE7 CONTAIN ME ; �, - ; ♦ om*d mesh all statutory rsqueamwrM for tossing SURVEYORS NAME AND LICENSE NUMBER. 1 y .y /J �j � •IRS............ 1/2•IRON ROD 5ET min?rum CV ¢�0 �/!/+ . •DP EXLSINEC N70N PIPE AS SHOWN /ReMar Olapr Dale •I/O,..........EXIS7INO IRON ROD AS SHOWN 1 dot I X CP............crodourEa POINT P.B. 66, Pg. 85 y 31t SSS............SURVEY SPMf SEr Coons Noting w.tane• smEEr_-. Ownership & Dedication Certificate `S• •5s'Om' 107.9' )Y RL 1Y POLE z for Corporations, LLCs or Non—profits s'S'. Li N°Rf9e 1b. . A.•}.................. WATER NY VALVE elfin r•4-1. � • 602'J.'♦ A� 1,171 sweet'Mat R am(wW ra)the deer(7) fir. x PROPOSED RED AMPLE rote t.4 dweRd nenn,rhkh propry b/none at I Me hems q ' PIN..........PARCEL IDENTIFICATION NUMBER -y h. rsaMaen t eubdoon of!bf°Me 1.to that I e al Maw adept N 6ax'1• RCP REINFORCED CONCRETE PIPE a.a enUst 1. at ouch a sad drdkMe to ap ore all groat shown i N SC36'J"MIIMBI]tl• I w this peer mem a•mesh.lMp.walla park,open and and .c T 111[1.516 Se)a'1 �il&3{� EP..........-EDOf Or PAVFMENf m/ ucpr Nees ap teas un Mdcale as fwhom4.4/ and not I MM1• ',Kr iZ��{d3'�sun ldn NOW OR FORMERLY 0 (We)rW maintain elf wee awe ores Me Nee al I. WWWW� LID•I N r:'_;am—EI1T>i a h memte by ow eprowlate pods eulnallItt��M pnprty No.w (I(t1 iF2YTf[mIlEF1[F� r ..... RIO 7 Of WAY IT this plot.dedkmd far a potato us,she 2e deemed to be I�il ii a 5245•A��21F.'•� /r71 NOT 3 SCALE h•J °admothers�e a pPn.d for ans ether public CaeeMo Camlld by law.•on such N }a31 T .. .....—.LINE SURVEYED '•p Ell9'SI' 1 —WE WE SURVEYED • ----_UNE NOT SURVEYED O J a /c� i.( ININg Are 19 Lino Only I . Y' -.1• ._RIGHT-OF-WAY LINE 0. Name W Non-reml —of—OVERHEAD UTILITY LINE Cum R°dlu• I twpU Chad Chard Boor. NMI e.WeR A 7 z CI 17. NOW A460 Tt eS0• r w Nob: sy(PnMdwt.+W . wlvey • 80 0 80 180 240 Individual driveway ornaments are 10'wide and extend centerine LA2'DR G su su Z t•ttttttt, of rood to 20'post R Ike as shown. MOM(Secretary eignmun) Der* GRAPHIC SCALE-FEET!• 80' T. Major Subd/vision or:. Shored driveway easements are a 20'wide 10'an each aide of property Notary Spring Farms line and Mond from the centerline 1/2'OR Nash Comma.C°Iowa Couty TZDof rood to 20'pant R/w dim..as NO.. 111teu3SA•.mpinruElAls,a Nefry Pork fir.ex Clines Township, Catawba County, NC �i-yBflw rowdy wa riotb do nrMy corny that arM"g:. r Owners of Record: MartinRay Holding, LLC f)uSTld Mott. f� + �y Deed Reference: D.B. 3736, Pg. 792 >�/fvf �,,„' ion•oi••1•••••due rnyemu outer o Mr nto P dey end wh,ewead HOTAIpy�4 Plot Reference: NSA !�' P�`e� Zoning N PIN: 3734-1175-2255 Proudly Surveying/rsd.N Canny 2DdNa R-20(Catorbe County) biller.my hod ad ofodd seal At't ULtG Job Number:2 1 1 138083.DWG (3111380.CRD) Since lgea MAINSsrbetar can M.d9r`asy at Qut+�E.t !� 2022. a° Field Work: 12-2-2021 03O SIGNAL HILL DRIVE 04) 76 98,9I E,NC 18823 lOont Ir �.LA)vS•` '14 e i.9. ' <c?... ,p.;, Plat Dote: 8-29-2022 MOVE(70A)8 STAIES l wwwboundorydevelopmen t.cam Roo-- 3p• MOleer ob '""e�.nw ty eanmxsen amide `1JC'Qhf'ti lt,?47ti—__ Drawn By: WSR FOOD Sop 46,2022 ETA6 BAl BOON 0006e NNA HICKS NTY NC SPENCER DONNA HICKS SPENCER81.4r \ 91..."1 PAGE 0787 REGISTER OF DEEDS INST R 19526 _ 19 a - .