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HomeMy WebLinkAboutEOP-08-2023-202311.tif Engineer Option Permit Common Form LHD Reference: '� �" ZOZ5 201 / ' PART 3: Authorization to Operate(ATO) Except for date received,the Section below is to be completed by the Owner or the PE. LHD USE ONLY: Initial submittal of request for ATO received: /Z.-1'211 by tee �i Date Initials Date of Post-construction Conference: frk- Post-construction Conference waived in accordance with G.S.130A-336.1(j): /44- he following items are included in this submittal for an Authorization to Operate under an EOP: 1. Signed and sealed copy of the Engineer's report that includes the information in G.S. 130A-336.1(k)(1)and 15A NCAC 18A.1971(f) D Yes ❑No 2. Operation and management program and ORC contract,if applicable ElYes El No 3. Fee (as applicable) ❑✓ Yes ❑No 4. Notarized letter documenting Owner's acceptance of the system from the PE ElYes ❑No 5. Owner meets requirements of ownership or control of the system per 15A NCAC 18A.1938(j) ❑✓ Yes ❑No 6. Easement,right of way,or encroachment agreement required per 15A NCAC 18A.1938(j) ❑Yes El No 7. Multi-party agreements required,as applicable,pursuant to 15A NCAC 18A..1937(h) ❑Yes ElNo If yes,agreements filed in County Register of Deeds in Deed Book Page Attestation by the Owner or the PE for Authorization to Operate Brett G. Schaefer I, hereby attest that all items indicated above have been provided to the Print name of Owner or Professional Engineer County LHD and the system shall meet applicable federal,State,and local laws, regulations,rules and ordinances in accordance with G.S.130A-336-.1(e)(6). /�r^1'�' �•�x�� 6/2 7/2 4 Signature of Owner or Professional Engineer 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 EOP: • Copies of this signed form were sent to the design PE 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-336.1(m). A copy of this complete NOl/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. DHHS/EHS/OSWP—EOP COMMON FORM Updated April 2022 Page 6 of 6 Atternative Septic Services, LLC 803-242-2639 AlternativeSepticServices.com June 27,2024 Alternative Septic Services,LLC Re: 8450 Timberlake Lane,Terrel,NC Alternative Onsite Wastewater Treatment System As-Built PIN: 06-093-008 Gentlemen: Enclosed is the As-built plan for 8450 Timberlake Lane,Terrel,North Carolina as installed by Alternative Septic Services,LLC(NC Certification: 6821)on June 26,2024. This system was installed as designed. The drain field was observed to be in the general location as originally designed and using all components from the original design on the south side of the four(4) bedroom residence. The drainfield components meet all horizontal (minimum 10 feet from property lines) and vertical (minimum 12 inches above a restrictive horizon) setbacks as designated by NCDEQ regulations 15A NCAC 18A, Sanitation, Section .1900, Sewage Treatment and Disposal Systems. Please note that the as-built location and/or orientation of the wastewater treatment system tanks may vary from the proposed location and/or orientation during construction due to site conditions and building placement. The tanks also adhere to the setbacks (minimum 5 feet from the property line and building) ,-- provided by NCDEQ regulations 15A NCAC 18A, Sanitation, Section .1900, Sewage Treatment and Disposal Systems,regardless of tank orientation. The as-built plan has been completely analyzed and should function as intended. I recommend fmal approval. Sincerely, Brett G. Schaefer,PE \���i�tirrrr,/ ` .4*.‘F�ssio•.z4 •ct SEAL 9� 036114 "PA..'cN• GINE��•cce, //i G.SCNP `\ . F t I / / co a / co /0 m 2. % \ ✓ 2 m \ n m % I m %/ y N FT • • �_ I �' /ems 1 . i n � ji•� \ �� l .1:+363 II :--__ --....:.." N. /V ./ .._____.........,..... ..: _______ .-=-7.--.... ..,_ . cn j \ u° r/ `\ <�G a o II 11 AO I ¢ d I 2I \\ // N. y I Y r .., 1111 m puwmro o'�3 _w; "y`• apse �g m m fro urrrr g39 v ll m< roll 'o F - e STATE q. � ,,,,,,, 4o�•�,, ROY COOPER•Governor y``P ` ' o ''y NC DEPARTMENT OF KODYH.KINSLEY•Secretary !��?� 4 o HEALTH A N D �,!`` ��- HUMAN SERVICES HELEN WOLSTENHOLME•Interim Deputy Secretary for Health a; .x:;= MARK T.BENTON•Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR ENGINEERED OPTION PERMIT See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the Professional Engineer licensed in accordance with G.S.89C LHD USE ONLY: Initial submittal of this NOI received: by Date Initials PART 1:Notice of Intent to Construct(NOI)-Please check all that apply El Single System or ❑Multiple Systems AND ElNew ❑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.): Mailing address:8450 Timberlake Lane. City: Terrell State: NC Zip: Telephone number: E-mail Address: 2. Professional Engineer(PE)name: Brett G. Schaefer License number:036114 Mailing address:6945 Curlee Court City: Charlotte State: NC Zip:28277 Telephone number: 631-786-4601 E-mail Address: Brett@alternativesepticservices.com 3. Licensed Soil Scientist(LSS)name: Steven J. Melin License number: 1254 Mailing address: 15 Love Coyote Ridge O. Fletcher State: NC Zip: 28732 Telephone number: 828-551-9903 E-mail Address: SJMelin@gmail.com 4. Licensed Geologist(LG)(if applicable)name: License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 5. On-Site Wastewater Contractor name:Brian Grissom License number: 6821 Mailing address: 168 Hwy 274, Ste 155 City: Lake Wylie State:SC zip:29710 Telephone number: 803-627-4917 E-mail Address: Brian@alternativesepticservices.com 6. Proof of Errors and Omissions or other appropriate liability insurance for the following persons is attached that includes the name of the insurer,name of the insured and the effective dates of coverage: ❑✓ PE ❑✓ LSS ❑ LG ❑✓ On-site Wastewater Contractor NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Raleigh,NC 27609 MAILING ADDRESS:1642 Mail Service Center,Raleigh,NC 27699-1642 www.ncdhhs.gov • TEL:919-707-5874 • FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Engineer Option Permit Common Form LHD Reference: 7. Property location(physical address,tax parcel identification number or subdivision lot,block number of the property to be permitted): PIN: 4616-0149-5033 County Name:Catawba 8. 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: 9. Factors that would affect the wastewater load: N/A (Domestic Wastewater) 10. Type and location of proposed wastewater system:Engineered Wastewater Treatment System (Type Vc) Located on property(Figure 1). System is for 4BR residence. 11. Design wastewater flow:480 gpd(For flow>3,000 gpd and industrial process,duplicate plans shall be sent to the State.) Design wastewater strength: 0 domestic ❑high strength ❑industrial process 12. A plat as defined in G.S. 130A-334(7a)is attached: Q Yes ❑No 13. Location of proposed or existing wells(drinking water,irrigation,geothermal,groundwater monitoring, sampling,etc.)and any potable and non-potable water conveyance lines is indicated on attached plans and complies with 15A NCAC 18A.1950: El Yes ❑No This is a saprolite system. ❑Yes El No 14. Evaluation(s)of soil conditions and site features in accordance with G.S. 130A-335(a1)signed and sealed by a LSS is attached: Q Yes ❑No 15. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes I NA 16. Proposed landscape,site,drainage,or soil modifications are attached: ❑Yes 0 NA Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C Brett G. Schaefer hereby attest that the information required to be included with Registered Professional Engineer(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 in accordance with G.S. 130A-336-.1(e)(6). 4/7/23 Signature of Licensed Professional ngineer Date DHHS/EHS/OSWP—EOP COMMON FORM Updated April 2022 Page 2 of 6 Engineer Option Permit Common Form LHD Reference:• This section is for Owner use to either designate PE as their legal representative or to self-submit the NOI. Designation of Registered Professional Engineer as legal representative of Owner for this Notice of Intent: I, hereby designate Print Name of Owner Print Name of Registered Professional Engineer as my legal representative for purposes of this Notice of Intent pursuant to G.S.130A-336.1. Signature of Owner 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 NOTES: LIABILITY: The Department, the Department's authorized agents,or local health departments shall have no liability for wastewater systems designed,constructed,and installed pursuant to an Engineer Option,Permit[G.S.130A- 336.1(f)] 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—EOP COMMON FORM Updated April 2022 Page 3 of 6 Engineer Option Permit Common Form LHD Reference: This section for Local Health Department use only. PART 2: LHD Completeness Review of the Notice of Intent to Construct "(c)Completeness Review for Notice of Intent to Construct.—The local health department shall determine whether a notice of intent to construct,as required pursuant subsection(b)of this section,is complete within 15 business days after the local health department receives the notice of intent to construct. A determination of completeness means that the notice of intent to construct includes all of the required components. If the local health department determines that the notice of intent to construct is incomplete,the department shall notify the owner or the professional engineer of the components needed to complete the notice. The owner or professional engineer may submit additional information to the department to cure the deficiencies in the notice. The local health department shall make a final determination as to whether the notice of intent to construct is complete within 10 business days after the department receives the additional information from the owner or professional engineer. If the department fails to act within any time period set out in this subsection,the owner or professional engineer may treat the failure to act as a determination of completeness." The review for completeness of this Notice of Intent was conducted in accordance with G.S. 130A-336.1(c). This NOI is determined to be: ❑ INCOMPLETE(If box is checked,Information in this section is required.) Based upon review of information submitted in Part 1,the following items are missing: Copies of this form listing missing items were sent to the design PE and the Owner on Date via with directions to re-submit missing items using Page 5 of this form. Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date ❑ COMPLETE(If box is checked,information in this section is required.) Based upon review of information submitted in Part 1 of this form,this NOI is deemed COMPLETE. Copies of this signed form were sent to the design PE and the Owner on via Date Email,FAX,USPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date DHHS/EHS/OSWP—EOP COMMON FORM Updated April 2022 Page 4 of 6 Engineer Option Permit Common Form LHD Reference: Re-submittal of NOI with missing items included This Section Is for use by the owner or PE to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the PE. LHD USE ONLY: This NOI resubmittal received: by Date Initials Item#from initial NOI Resubmittal description Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C I, hereby attest that the information re-submitted for this Notice of Licensed Professional Engineer(Print Name) 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 in accordance with G.S.130A-336- .1(e)(6). Signature of Licensed Professional Engineer 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- 336.1(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 design PE 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 PE 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—EOP COMMON FORM Updated April 2022 Page 5 of 6 Alternative Se ServicesIIC r 168 Highway 274 #155 Clover, SC 29710 803-242-2639 February 15, 2022 To Whom It May Concern: Brett Schaefer Professional Engineer, Steve Melin Soil Scientist, and Brian Grissom Onsite Wastewater Contractor/Installer are covered under the liability umbrella policy UL90727799 (see attached). Please contact us with any questions or concerns. Thank you, /ica Alternative Septic Services Sal Vicari 168 Hwy 274 #155 Clover, SC 29710 803-242-2639 A ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/20/2022 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 Holly Parrish NAME: Correll Insurance Group-Rock Hill (AHCNJ FAX Extl: (803)324-2984 F No): 319 Oakland Ave E-MAIL hparrish@correllinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Rock Hill SC 29730 INSURER A: Pennsylvania National Mutual Casualty Ins Co 14990 INSURED INSURER B: Accident Fund Alternative Septic Services LLC INSURER C: National Fire&Marine Insurance Company 168 Highway 274 Suite 155 INSURER D: INSURER E: Clover SC 29710 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 Master(4) 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) (MMIDDIYYYY) LIMITS i X COMMERCIAL GENERAL LIABILITY 1,000,000 _ EACH OCCURRENCE $ DAMAGE RENTED CLAIMS-MADE n OCCUR PR M SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A GL9 0727799 03/09/2022 03/09/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jE n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED AU90757292 07/24/2022 07/24/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) X 19 Underinsured motorist $ 1,000,000 X UMBRELLA LIAB �"""""CCURR NCE 1,000,000 OCCUR EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE UL9 0727799 03/09/2022 03/09/2023 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION vI PER ' OTH- AND EMPLOYERS'LIABILITY ^I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT s 1,000,000 B OFFICER/MEMBEREXCLUDED? r-iN/A AF WCP 100019726 01 04/04/2022 04/04/2023 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Occurrence $1,000,000 C Professional Liability F85108221AEM 07/09/2022 07/09/2023 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Covered under above listed policies are: Brett Schaefer-Professional Engineer,Steven Medlin-Licensed Soil Scientist,Brian Grissom-On-Site Wastewater Contractor,Matthew Velkovich- Professional Engineer CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN North Carolina Public Health ACCORDANCE WITH THE POLICY PROVISIONS. Health and Human Services AUTHORIZED REPRESENTATIVE 6:19- V I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD - . Alternative Septic Services LIC June 27,2024 Mr.Brett Schaefer,PE 6945 Curlee Ct Charlott'e,NC 28277 Mr..Schaefer, An EOP was obtained from the Henderson County Department of Public Health for a proposed septic system at 8450 Timberlake Lane,Terrell,NC The septic system as set forth in the EOP was installed by Alternative Septic Services,LLC(Brian Grissom #682I)and inspected by. Steve WE hereby accept the engineered septic system as installed by Alternative Septic Services,LLC as being completed in accordance with specifications set forth in the EOP documents. Sincerely, 5.13.6\r\gs . /TNT, Or State of k\kft\A Caro1k county of cdczte_t_,,),:\e::,,,•-,, . L5 uictLa • Mutat, Fe"-- , a otary for ounty, State of A../. da-lier4eby certify that --5/- rscA-51+ , , personally appeared before me this day and acknowledge the due execution of the foregoing instrument. Witnessed my hand an official seal,this August day of ail,2024 , ' ',.,MiRgUSBOWLING 4tgryPtiblic-North Carolina r,,`; .:1441.0frovntY 'MjiCOrrirlASMpri txptres Mar 27,2027 fY) t&-4' 174Seal 7-- , • 0'4 41! Alternative Septic Services, LIC 168 HWY 274#155 Lake Wylie, SC, 29710 June 27, 2024 Re: 8450 Timberlake Lane, Terrell,NC Alternative Onsite Wastewater Treatment System Dear Environmental Health, This letter is intended satisfy the requirement that the system at 8450 Timberlake Lane, was installed according to recommendations in the Engineering and Soil Scientist Report. I hereby certify that the system was installed consistent with the Engineering and Soil Scientist Report. This included installing a pretreatment(Clear Stream)tank that feeds a total of 960 linear feet of GeoFlow drip irrigation tubing for the 4-bedroom residence. I greatly appreciate your time. Please feel free to contact me if additional information is required. Kind Regards, ,:r .n Grissom, Certified Septic Installer(Level IV)—Certification#6821 Alternative Septic Services 803-627-4917 1 iriteamt Alf roe ri ," Atternative Septic Services LIC HWY 21-4 1016.5 279710 „:, , :„, ;:1:::::-7:0000**iinniii***4000.0i,oNi000rorirrroairi:j***00400,.4**0:40::,;(1100:, Yors 01'0.'4;41'4Y 4114., h.on iv;,,inicrionce or, t drin Y,17dent- Yr ic s prafOrnicKI by a It:aim:Kt ar. t,::ire•A, (iatrficiJ NC$4.1rAur1acktf.:tsrrigor), Iota maritiertneicrr inducks: T:101 NM and ATU for proN1 iur LI1 sem iiaffsrsti)wd labonimry. hLF Mid din needed aisd eteari air fihicr„ itkaj quzdtly and neatnumt witn:fof Ea:ratio-IL 400 This agettritcm mot cova die% e,fl‘didsizim:11.$44rvicky...1,45;its,4( fiectsiwy)of the Tepair or frpliiKst'alefit of cotr4oitzii t NA%rot rzrd mndel r11411;d0sett1ICS, srl! s gs104: AitC•MsaWi'eS4jrnc SI Ain Kr tom i; or7irr!c,:i the Eirransovrirr,,ptii e!ri rup4ibix for k r14-inkra:4--;,,,4 F4ringain inxid.L17,;?„11:c." *'114„ bv do rA,by- 4 c,"ii fit d piovider licensed Seam/I r Thz n t j1,1'1,1f t":,,i4tLIZi:i N. I a), 3P4orcr 7ivig fn."' curtc nl y,offr,r;rn i r4tctiattcv;Ai 5750AX)arir,:1411y,„ )"4,-.-4;r: ith pi chonst=wally r 2eTrae:uv ilaill,fcreth;1(4 r(7:0;kfAi-ceAtts „ . A•S?„:4.;,t*:: 'X',#('Vte : ' 1„ ": , IF.Ikpt‘640.kreff4104i.PWA71 :::','S;:iSllif!550,4%! • , Alternative Septic Services ices LLC 15 LONE COYOTE RIDGE;FLETCHER,NC 28732 EMAIL SJMELIN@GMAILCOM CELL(828)551-9903 July 12, 2024 Re: 8450 Timberlake Lane,Terrell,NC Alternative Onsite Wastewater Treatment System Parcel ID #: 06-093-00 To whom it may concern, This letter is intended satisfy the requirement that the system at 8450 Timberlake Lane,Terrell,NC was designed and installed according to recommendations in the Soils Report. I hereby certify that the system was installed consistent with the Soils Report. This included installing a Clearstream treatment unit that feeds 800 linear feet of drip irrigation tubing for the 4-bedroom residence. Please note that the 0.25 LTAR and 48"drip depth were utilized as specified in the Soils Report. I greatly appreciate your time. Please feel free to contact me if additional information is required. Kind Regards, I O Steven J. Melin,LSS Alternative Septic Services, LLC 1 GiGi Mudd From: Kara Garvey <kara@alternativesepticservices.com> Sent: Monday,.December 9, 2024 3:46 PM To: EH Administrative Assistants Subject: 8450 Timberlake Lane close out Attachments: NOI_8450 Timberlake_20240627_FINAL.pdf Warning: Unusual sender<kara@alternativesepticservices.com> ____ — , You don't usually receive emails from this address. Make sure you trust this sender before taking any actions,____; Good afternoon! I need to close out this EOP.I have attached the paperwork.Please let me know how to proceed. Tlha 11<46 1(c 4 c t Qc rve'y Ad 4,ivaztea ve/Asi,.stant Coil::803-616-7570 Alternative Septic Services, LLC 803-242-2639 AlternativeSepticServices.com 7 1 ..s1'+�,v CATAWBA COUNTY 4 Cox• WELL-08-2023-203065 • 0 lib;, Public Health Department Subdivision J C HOW4RD PROP %I.i,u . P. Environmental Ham'Division PIN" 481t301495033 4.....� PO Box 329,25 Government Drive,Newton,NC MilLOTI 8 :;lt Stt.Address: 8450 TIMBERLAKE LN,TERRELL NC 28882 Name on pm* ANDREW PRATT Property hie: Acres 0.77 one : Hwy 16 S, Left on Hwy 150, Right Kiser Island,Right Fieldstone, Left Beachwood, Right Timberlake Owner/Authorized Representative Acknowledgement of Permit Receipt /4;..."--- required)representing the I od'dfi thu I am the owner or authorized agent(owner's authorization epr g owner of the ., described above. As the property owner or authorized representative,I have received the above referenced permit(s)as requested in the application for service RBPR-08-1023-45155,by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) 4 As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and further understand that all applicable regulatory requirements specified under the NortS Carolina Laws and Roles for Sewage Treatment and Disposal Systems(1SA NCAC 18A.1900), sod/or Well Construction Standards(I5A NCAC 2C.0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date:08/22/2023 Owner/Au rized Representative Sign ...-"/ Date Documentation of Permits)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person se ing permit) SignatureDite _--Date/lime_ i9_11).3 Method: Fax Email US Mall Other Owner's request to seed by the above indicated method of transmittal In lieu of signature We want tto hear from yoiPiesse take a few momentts tto eornplette our custtomer service survey att http://www.survaymonitey.com/s/tHCusttomarServka Ammo' Ut/23R023 Uu 44 cop ,. .OTs.)9)3,X)31 1 Tre� :.. / 5/4' ROY COOPER•Governor MS')0)3 -�l5 47 4� y�:.. NC DEPARTMENT OF " KODY H.KINSLEY•Secretary � HEALTH AND HUMAN SERVICES HELEN WOLSTENHOLME• Interim Deputy Secretary for Health +• Qw �; MARK T.BENTON•Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR ENGINEERED OPTION PERMIT See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the Professional Engineer licensed in accordance with G.S.89C LHD USE ONLY: Initial submittal of this NOI received: 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.): Mailing address:8450 Timberlake Lane City: Terrell State: NC Zip: Telephone number: E-mail Address: 2. Professional Engineer(PE)name: Brett G. Schaefer License number: 036114 Mailing address:6945 Curlee Court City: Charlotte State: NC Zip: 28277 Telephone number: 631-786-4601 E-mail Address: Brett@alternativesepticservices.com 3. Licensed Soil Scientist(LSS)name: Steven J. Melin License number: 1254 Mailing address: 15 Love Coyote Ridge City: Fletcher State: NC Zip: 28732 Telephone number: 828-551-9903 E-mail Address: SJMelin@gmail.com 4. Licensed Geologist(LG)(if applicable)name: License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 5. On-Site Wastewater Contractor name: Brian Grissom License number: 6821 Mailing address: 168 Hwy 274, Ste 155 City: Lake Wylie State: SC zip:29710 Telephone number: 803-627-4917 E-mail Address: Brian@alternativesepticservices.com 6. Proof of Errors and Omissions or other appropriate liability insurance for the following persons is attached that includes the name of the insurer, name of the insured and the effective dates of coverage: ❑✓ PE ✓❑ LSS ❑ LG On-site Wastewater Contractor RECEIVED NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Raleigh, NC 27609 J U L 3 1 2023 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