HomeMy WebLinkAboutAUTH-09-2023-203964.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
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4.6Ik'nbu 09/07/2023 16:44
` Permit#:40t1-a%-21123-203 9( if
CONSTRUCTION AUTHORIZATION FOR G.S. 130A-335(a2)
County: Catawba
PIN/Lot Identifier: 375116826852
Issued To: Nicholus Johnston
Property Location: 2832 Keisler Dairy Road, Conover, NC 28613
AOWE/PE Plans/Evaluations Provided: Yes El] No❑ If yes,name and license number of AOWE/PE: Larry Thompson, AOWE#10016E
Facility Type: Single-Family Residence
p New ❑Expansion ❑Repair ❑System Relocation ❑Change of Use
Basement? ❑Yes p No Basement Fixtures? ❑Yes ❑✓ No
Type of Wastewater System* Accepted (Initial) Accepted (Repair)
*Please include system classification for proposed wastewater system types in accordance with 15A NCAC 18A.1961 Table V(a)
Design Daily Flow: 360 GPD Wastewater Strength:❑✓ domestic ❑high strength ❑industrial process
Session Law 2014-120 Section 53,Engineering Design Utilizing Low-flow Fixtures and Low-flow Technologies? 0 Yes 0 No
(if yes,please provide engineering documentation)
Installation Requirements/Conditions
Septic Tank Size: 1,000 gallons Total Trench/Bed Length: 330 feet Trench/Bed Spacing: 9 feet on center
Trench/Bed Width: 36 inches LIAR: 0.275 gpd/ft2
Soil Cover: 6 inches Slope Corrected Maximum Trench/Bed Depth*: 20 inches s Measured on the downhill side of the trench
Aggregate Depth: N/A inches above pipe N/A inches below pipe 12 inches total
Pump Tank Size(if applicable): N/A gallons Requires more than 1 pump? ❑Yes ❑✓ No
Pump Requirements: ft.TDH vs. GPM Grease Trap Size(if applicable): N/A gallons
Distribution Method: ❑Serial El D-Box or Parallel ❑Pressure Manifold(s) ❑LPP ❑Other:
Artificial Drainage Required: Yes❑ No❑J If yes,please specify details:
Legal Agreements(lf the answer is"Yes"to any type of legal agreements,please attach a copy of the agreement.)
Multi-party Agreement Required[.1937(h)): ❑Yes ❑✓ No
Easement,Right-of-Way,or Encroachment Agreement Required[.1938(j)]: ❑Yes ❑J No
Declaration of Restrictive Covenants: ❑Yes Q No
Pre-Construction Conference Required: Yes❑✓ No❑
Conditions:
The construction and installation requirements of Rules.1950,.1952,.1954,.1955,.1956,.1957,.1958,and.1959 are incorporated by reference
into this permit and shall be met. Systems shall be installed in accordance with the attached system layout.
AOWE/PE Print Name: Larry Thom Ive i Expiration Date: December 31, 2023
AOWE/PE Signature: _+�,F _-�11 Date: 07-29'23
This A r(EJ E-?4 ittal is pursu t to and meets the requirements of G.S.130A-335(a2)and(a5).
*See attached site sketch*
G.S. 130A-335(a2)Common Form 4 V.2023.07
• Permit#: Auth-09-2023-203964
2832 Keisler Dairy Rd
This Section for Local Health Department Use Only
Initial submittal received: 8/31/2023 by RP
Date initials
G.S. 130A-335(a5)states the following:
When an applicant for a Construction Authorization,or an improvement Permit and Construction Authorization together,submits a Construction Authorization,or an
improvement Permit and Construction Authorization application together,the permit fee charged by the local health department,the common form developed by the
Department,and any necessary signed and sealed plans or evaluations conducted by a person licensed pursuant to Chapter 89C of the General Statutes as a licensed
engineer or a person certified pursuant to Article 5 of Chapter 90A of the General Statutes as an Authorized On-Site Wastewater Evaluator,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 Construction Authorization or Improvement Permit and Construction Authorization includes all of the required components.If the local health department
determines that the Construction Authorization or improvement Permit and Construction Authorization is incomplete,the local health department shall notify the
applicant of the components needed to complete the Construction Authorization or Improvement Permit and Construction Authorization.The applicant may submit
additional information to the local health department to cure the deficiencies in the Construction Authorization or Improvement Permit and Construction
Authorization.The local health department shall make a final determination as to whether the Construction Authorization or Improvement Permit and Construction
Authorization 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 applicant may
apply for the building permit for the project upon the decision of completeness of the Construction Authorization or Improvement Permit and Construction
Authorization by the local health department or if the local health department fails to act within five business days.The Authorized On-Site Wastewater Evaluator or
licensed engineer submitting the evaluation pursuant to this subsection may request that the local health department revoke or suspend the Construction
Authorization or Improvement Permit and Construction Authorization for cause.Upon written request of the Authorized On-Site Wastewater Evaluator or licensed
engineer,the local health department shall suspend or revoke the Construction Authorization or Improvement Permit and Construction Authorization pursuant to G.S.
130A-23.The Department shall develop a common form for use as the Construction Authorization.
The review for completeness of this Construction Authorization was conducted in accordance with G.S. 130A-335(a5). This
Construction Authorization 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 AOWE/PE and the Applicant on
Date
State Authorized Agent: Date:
Q Complete
State Authorized Agent: nivatei Date of Issuance: 9/5/2023
This Construction Authorization is issued pursuant to G.S.130A-335(a2)and(a5)using the signed and sealed plans or evaluations
attached here.This Construction Authorization is subject to revocation if the site plan,plat,or the intended use changes. The
Construction Authorization shall not be affected by a change in ownership of the site. This Construction Authorization 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
plans,evaluations,preconstruction conference findings,submittals,or actions from a person licensed pursuant to Chapter 89C of
the General Statutes as a licensed engineer or a person certified pursuant to Article 5 of Chapter 90A of the General Statutes as an
Authorized On-Site Wastewater Evaluator in GS 130A-335(a2),(a5),and(a7).The Department,the Department's authorized
agents,and the local health departments shall be responsible and bear liability for their actions and evaluations and other
obligations under State law or rule,including the issuance of the operations permit pursuant to GS 130A-337.
Construction Authorization Expiration Date: 9/5/2028
*See attached site sketch*
G.S. 130A-335(a2)Common Form 5 V.2023.07
1 - -
•
•
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
•
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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
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Evaluated by: 0 r W 66 / 'mow. +.' "
L. Thompson, LSS r ` ,, 1287 40
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.....„....„
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
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,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.
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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