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HomeMy WebLinkAboutIMPV-09-2023-203963.tif DocuSign Envelope ID:7A6E8AC7-6A67-4772-AC89-46C6AE288AC3 A'=4 CATAWBACOUNaTY y -�.�1 Public Health Department Subdivision 3 Js,, Environmental Health Division PINK 375116826852 PO Box 389,25 Government Drive,Newton,NC 28658 LOT! Site Address: 2832 KEISLER DAIRY RD,CONOVER NC 28613 Name on Permit: 'FOUR CORNERS OF CHARLOTTE LLC Property Size: Acres 0.89 Directions: 2832 Keisler Dairy Rd, Conover Owner/Authorized Representative Acknowledgement of Permit Receipt rt I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of 4— the property described above. OS ICC 11 As the property owner or authorized representative,I have received the above referenced permit(s)as requested in the application for service RBPR-08-2023-45354,by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) 7 Electronic Image Transmittal/E-mail (Return receipt required) "—De lc rt 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 North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC ISA.1900), and/or Well Construction Standards(15A 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:09/05/2023 DocitCainrin.uSIgned by: Owner/Authorized Representative Signature� I� �� _ 1 �D2dfi1'.- Date 9/8/2023 1 6:21 AM PDT Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by _ _ (name of person sending permit) (1 Signature_ E 1 _ _ Date/Time COI�1 )3 Method: Fax I Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yoaPlease ttake a few momentts tto complette our custtomer service survey aft httpWwww.surveymonkey.com/s/EHCusttomerService ro mew°30 fetus°.cal 4.6Ik'nbu 09/07/2023 16:44 • Permit#: JAW'09- 2.02-3-2•3 qb3 •wa-r► fati ROY COOPER •Governor °4a J '; `.y, NC DEPARTMENT OF KODY H. KINSLEY• Secretary r . HUMAN SERVICES MARK BENTON • Deputy Secretary for Health .4 4 SUSAN KANSAGRA•Assistant Secretary for Public Health Division of Public Health Submittal Includes: ❑✓ (a2)Improvement Permit (a2)Construction Authorization H Fee$_ _ IMPROVEMENT PERMIT FOR G.S. 130A-335(a2) County: Catawba PIN/Lot Identifier: 375116826852 Issued To: Four Corners of Charlotte LLC Property Location: 2832 Keisler Dairy Road, Conover, NC 28613 Subdivision(if applicable) Lot#: Block: Section: LSS Report Provided: Yes❑✓ No❑ If yes,name and license number of LSS: Larry Thompson, NCLSS#1208 New❑J Expansion El System Relocation El Change of Use El Proposed Structure: New Single-Family Residence Number of bedrooms: 3 Number of Occupants: 6 Other: Design Wastewater Strength:❑✓ domestic E high strength El industrial process Proposed Design Daily Flow: 360 GPD Proposed LTAR(Initial): 0.275 Proposed LIAR(Repair): 0.275 Proposed Wastewater System Type*: Accepted (Initial) Pump Required: 0 Yes ❑✓ No El May be required Proposed Wastewater System Type*: Accepted (Repair) PumpRequired: q uired: El Yes ✓❑No El May be required *Please include system classification for proposed wastewater system types in accordance with 15A NCAC 18A.1961 Table V(a) Saprolite System(initial):0 Yes ❑✓ No Saprolite System(repair):El Yes ❑✓ No Fill System(Initial):❑Yes ✓❑No If yes,specify:El New El Existing (when adding more than 6 inches of fill to system area provide a fill plan) Fill System(repair):El Yes ❑✓ No If yes,specify:❑New ❑Existing (when adding more than 6 inches of fill to system area provide a fill plan) Usable Soil Depth(Initial): 32 Inches Usable Soil Depth(Repair): 32 Inches Max.Trench Depth(Initial)*: 20 Inches Max.Trench Depth(Repair)#: 20 Inches *Measured on the downhill side of the trench Artificial Drainage Required: El Yes ❑✓ No If yes,please specify details: Type of Water Supply:❑Private well El Public well ❑Shared well ❑d Municipal Supply ❑Spring ❑Other: Drainfield location meets requirements of Rule.1945: Yes Q No❑ Drainfield location meets requirements of Rule.1950: Yes❑✓ No❑ Permit valid for:❑✓ Five years[site plan submitted pursuant to GS 130A-334(13a)] ❑No expiration[plat submitted pursuant to GS 130A-334(7a)] Permit conditions: Licensed Soil Scientist Print Name: Larry Thomp. e. Licensed Soil Scientist Signature: „// Date: 07-29-23 The LSS evaluatia 4111111Fmitted pursuant to and meets the requirements of G.S.130A-335(a2). *See attached site sketch* NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Building 3,Raleigh,NC 27609 MAILING ADDRESS:1632 Mail Service Center,Raleigh, NC 27699-1632 www.ncdhhs.gov • TEL:919-707-5854 • FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 2832 Keisler Dairy Rd Permit#: IMPV-09-2023-203963 This Section for Local Health Department Use Only Initial submittal received: 8/31/2023 by RP Date Initials G.S. 130A-335(a3)states the following: When an applicant for an improvement Permit submits to a local health department an Improvement Permit application,the permit fee charged by the local health department,the common form developed by the Department,and a soil evaluation pursuant to subsection(02)of this section,the local health department shall, within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the Improvement Permit includes all of the required components.if the local health department determines that the Improvement Permit is incomplete,the local health department shall notify the applicant of the components needed to complete the Improvement Permit.The applicant may submit additional information to the local health department to cure the deficiencies in the improvement Permit.The local health department shall make a final determination as to whether the Improvement Permit is complete within five business days after the local health department receives the additional information from the applicant.if the local health department fails to act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The Department shall develop a common form for use as the improvement Permit. The review for completeness of this Improvement Permit was conducted in accordance with G.S.130A-335(a3). This Improvement Permit is determined to be: ❑Incomplete(If box is checked,information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Applicant on Date State Authorized Agent: Date: ©Complete State Authorized Agent: /7° l/br- Date: 9/5/2023 This Improvement Permit is issued pursuant to G.S.130A-335(a2)and(a3)using the signed and sealed LSS/LG evaluation(s) attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject to revocation if the site plan,plat,or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2). Improvement Permit Expiration Date: 9/5/2028 *See attached site sketch* G.S. 130A-335(a2)Common Form 2 V.2023.07 • • AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. PHASE PARCEL ID; 375116826852 STREET ADDRESS: 2832 Keisler Dairy Road Conover, NC 28613 Please print: Property Owner: Four Corners of Charlotte LLC 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): 1612 Seattle Slew Court, Waxhaw, NC 28173 Telephone: 704-713-2602 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: ramon gonzalez(Jul 29,2023 14:47 EDT( Date: Jul 29,2023 Date: Residential Subsurface Wastewater Treatment and Disposal System G.S. 130A-335(a2) Proposal for 2832 Keisler Dairy Road Conover, NC 28613 Tax Parcel Number: 375116826852 July 29, 2023 Prepared for: p sort Gk e � oMiOs/�y��r,, Four Corners of Charlotte LLC _ 1612 Seattle Slew Court 1 f ',�r c' �104. :y Waxhaw NC 28173 kr f�,` ''s 704-713-2602 °'•-�"' Atm Prepared by: s VI Larry Thompson, REHS, LSS i ...A,.•TE Thompson Environmental Consulting, Inc. • PO Box 541 ber c,e•tficsaaan ,. A Midland, NC 28107-0541 ` ii Phone: 704-301-4881 = • • 10416E Larry@thompsonenv.com - " . •' ''4i.U ► I. , , • 2832 keisler Dairy Road Project Specifics The following wastewater treatment and disposal system G.S. 130A-335(a2)proposal is submitted to Catawba County Environmental Health at the request of Four Corners of Charlotte LLC who proposes to construct a new 3-bedroom single family residence at 2832 Keisler Dairy Road, Conover,North Carolina. The residence will be served by a public water supply. Based upon a soil and site evaluation performed by TEC, it was determined that a sufficient amount of"Provisionally Suitable"Group IV soils are available for the installation and repair,of a Gravity Flow Accepted System for a 360 gallon-per-day residence at a 0.275 GPD/sq/ft long-term acceptance rate (LTAR). 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 Newton, take N. Main Street to E. 20th Street. Turn right onto E. 20`h Street, right onto Emmanuel Church Road, and left onto Keisler Dairy Road. Travel 1.4 miles and the property 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 • '2832 keisler Dairy Road Plans and Specifications A. Septic Tank 1. The septic tank shall be State approved (Section .1953 of 15A NCAC 18A), watertight, structurally sound, and 1,000 gallons in capacity. 2. The septic tank shall be fitted with an approved effluent filter. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tanks have had time to properly cure and are free of cracks or other structural deficiencies. B. Pipe, Fittings and Supply Line 1. All discharge piping, connectors, and supply lines should be made of SCH 40 PVC and fitted with pressure-rated couplings. 2. All joints must be properly "welded" utilizing the appropriate PVC cement for each application. C. Distribution Method 1. Individual drainlines shall be evenly fed via a distribution box. 2. Distribution box shall be water tested for equal flow at the time of the final inspection. D. Drainfield Installation 1. The drainfield has been previously laid out on-site utilizing metal stemmed flags. The property owner/builder should mark this area and isolate it as much as possible from construction traffic 2. Under no circumstances shall any construction take place within the drainfield area while the soil is in a wet condition. 3. The specified system is an accepted wastewater system, specifically the Infiltrator Quick 4 chamber system or any other system with a state-approved 25% reduction in required drainline length. 4. The drainfield consists of three (3) lateral trenches 3-foot wide by 110-ft long. Total trench length is 330 feet. 5. The maximum trench depth for this system shall be 20 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 I. The final soil cover over the drainfield shall be a minimum of 6 inches deep. 2. The drainfield shall be shaped to shed rainwater and be free from low spots. 3. The drainfield area should be planted with grass as soon as possible to prevent erosion. The soil should be properly tilled, limed(if necessary)and fertilized prior to planting. After '2832 keisler Dairy Road 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: 360 GPD—3 bedroom house Septic Tank Size: 1,000 Gallons (minimum) Effluent Loading Rate: 0.275 GPD per sq. ft. Drainfield Type: Accepted (25% Reduction) Distribution Method: Distribution Box Number of Drainlines (3) 3-ft Wide x 110-ft Long Total Trench Length: 330 Linear Feet Maximum Trench Depth: 20 Inches Repair Option Effluent Loading Rate: 0.3 GPD per sq. ft. Drainfield Type: Accepted (25% Reduction) Required Linear Footage: 330 Linear Feet Available Linear Footage: 330 Linear Feet • • '2832 keisler Dairy Road Maximum Trench Depth: 20 Inches • �!'� k d3 pT °ei 044, N �4R•r�� sn 4t,T r A/AT /4" 8t:p or, ? �4 res 1 A8 fi e /!. ` � s3o$ 28 R� r N EEp$4,4, / 3 ;' `s's 6506.43'01E 67r6, G.90 R Q1 , �, vF0 R Sg3g h0 I / 2 `p T S �9 `c.. J 7 �9 p O, of �l �, � ,Q� I F32365 8pr nr• ry \\ r 'i -A 'Z 1. tv / : O Q 4� CO-AO S • •R ajr,• . " U6BN r 4 •46 ' - •/6. i / t� �L,SN O Fq� U s / Z^' 'Co* 4 z 9, i)/ •4 / g r"/RF eV 11 e ^a �� /I�, V. . ti ) 7 I: '� ` o E41 Iiv g PO6? r F i� t / �'0R 97r 1, I 0 o-'s"cv qck� S R v�,,R ,�����peu Q s�c�,, rs s w Rye CIO ,$, ��is 96' •�Fqj' 4k00 Ck • r�$ y : H8 o LEGEND 00, '� 3 �/ R .��? •73 11, GIS 2-ft Contour Lines O4 7 Is '----,A, om. `�N'A 6�r",F Q Septic Tank ea r) 40 p OA Supply Line 44A.8 (/ rm.. Distribution Box J1pG AApr `� Septic Drainlines v ~4,4, ` Septic Repair Lines I "'" 1 li • Soil Boring Locations Date: Proposed Septic Layout July 2023 Figure Thompson Prepared For: fnvronrnenta Scale: Consulting 2832 Keisler Dairy Road 0 20 40 ft Four Corners of Conover, NC 28613 Charlotte LLC Catawba County TEC Job#: 23-225 Soil Evaluation Form Thompson Environmental Consulting,Inc. Sheet i of I PO Box 541 Job: Midland, NC 28107 2�32 k 'ik I R ��(I) (2+4 County:CAA W BA • Date:(,.2 f-23 Soil Borings f - .3 4 Landscape Position L5 C.3 C..S Ls Slope(%) to, r ii- 4 Horizon 1 Depth 0- I b- S� 0 _cj D-.5— _ Texture Ca_ G- CC CI, Consistence F{l. e(t r--p Fl., ' Structure G it G ill. G Q 66 it Clay Mineralogy 5 S Horizon 2 Depth Texture c_ G G c L Consistence FT - i-t ("-g (i Structure ' Sb1 S Y 5OIt 59 K Clay Mineralogy 5 S S s _ Horizon 3 Depth Texture Consistence Structure Clay Mineralogy Horizon 4 Depth Texture CP Consistence Structure • Clay Mineralogy _ Horizon 5 Depth Texture Consistence • Structure Clay Mineralogy • Soil Wetness Restrictive Horizon • _ ' Saprolite r';. Other ? 35` >2,5 5 3c 5 �` CLASSIFICATION , 15 i°5 1)5 P3 `., LTAR{gpd/hZ) 0�2�S Q,30 �.z�S O,2�5 Comments: tp sail se /� JC` $ THoM/, ti00 ( .-- Aire eti ra%-k Evaluated by: 0 r W 66 / 'mow. +.' " L. Thompson, LSS r ` ,, 1287 40 (__- ' G .....„....„ Pie.LSS evaluation is being submitted pursuant to and meets the requirements of G.S. 130A- 335(a2). Scanned with CamScanner 1/u1ck4TM STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) 12" 8„ 34" SIDE VIEW SECTION VIEW MultiPort End Cap -� 16" Ifs I �III 12" -T. 4Ifr ! ,AIPI4 34" SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size(WxLxH) 34"x52"x12" Size (W x L x H) 34"x16"x12" Effective Length 48" Invert Height 8"or 1.25" Invert Height 8" INFILTRATOR SYSTEMS.INC.STANDARD LIMITED WARRANTY (a)The structural Integrity of each chamber,end plate,wedge and other accessory manufactured by Infiltrator("Units"),when installed and operated eta leachlield of ar ensue septic system in eccordarce with infiltrator's Instructions,is warranted to the original purchaser("Holder")against defective materials and workmanship fa one year from the date that the septic permit is issued for the septic system containing the Units;provided,however, that if a septic permit is not required by applicable law,the warranty period all begin upon the dale that Installation of the septic system commences Toa exercise Itas warranty del .Holder must notify m In witting at Its Corporate Headquarters t Old Saybrook,Connecticut Warranty ty 1151 INFILTRATOR days of the alleged detect.Infiltrator volt supply replacement Units for Units determined by Infiltrator to be covered by this United Warranty Infitrators lablity specifically excludes the cost of removal and/or IrstalatIc n of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE.THERE ARE NO OTHER WARRANTIES WITH RESPECT R TO THE UNITS.INCLUDING NO IMPUED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE SYSTEMS I N C (ci This Linked Warranty shal 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.incbt➢ng loss of Environmental Onsite Wastewater Solutions" production end profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party.Specifically excluded kern Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse or neglect of the units;the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions:failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth In the instellobon Instructions:the placement of improper materials Into the system containing the Units;failure of the Units or the septic system due to improper siting or Improper sung.excessive water usage.improper grease disposal.or Improper operation;or Old Saybrook, CT 06475 any other event not caused by Infiltrator.The Limited Warranty shall be void if the Holder fails to comply with all of the terms eel forth in this Linked Warranty. 860-577-7000• FAX 860-577-7001 Further.In no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units.or any third party resulting from installation or ship- 800-221-4436 Went,or from any product liability clams of Holder or any third party. For this Limited Warranty to apply,the Units must be Installed H accordance with all site conditions required by state and local codes;all other applicable laws;and Infiltrator's installation instructions. (al)No representative of Infiltrator has the authority to change or extend this Urnhed Warranty. No warranty applies to any party other than the origi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states end counties have dherent warranty require meals.Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook,Connecticut,prior to such purchase,to obtain a copy of the applicable warranty,and should ceefuly read that warranty prior to the purchase of Units. U.S.Patents:4,759.661;5,017,041;5,156,488;5,336,017;5,401,118;5,401,459:5.511.903:5,718,183;5,588,778;5,839.844 's Canadian Patents:1,329,959;2,004,564 Other patents pending. r ' 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,MicroLeachirtg,PoyTutl,SnapLock,ChamberSpacer,PosiLock,OuickCut,OuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc.0 2003 Infiltrator Systems Inc.Printed In U.S.A. Q011203HP-0