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HomeMy WebLinkAboutEOP-09-2023-204355.tif EDP-01-203 —2035. ROY COOPER•Governor NC DEPARTMENT OF •tt t , KODY H.KINSLEY•Secretary �'v' - HEALTH AND !14� .`� ter ' HUMAN SERVICES MARK BENTON•Deputy Secretary for Health SUSAN KANSAGRA•Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR ENGINEERED OPTION PERMIT LHD USE ONLY: Initial submittal of this NOI received: by J" IM D e Initials RECEIV D PART 1: Notice of Intent to Construct(NOI)-Please check all that apply ❑ Single System or ❑ Multiple Systems SE P 8 2023 AND ❑ New ❑ Expansion ❑ Relocation of all or part of the Existing System ® Relocation o$80rytriental Health ❑ Repair—LHD Permit Number ❑ Repair—EOP/LSS COVID 19/AOWE Permit Number 1. Facility Owner's name: (Owner,Company Name, Utility, Partnership, Individual,etc.): Bennett Real Estate Holdings LLC Mailing address: P.O. Box 234 City: Newton state: NC Zip: 28658 Telephone number: 828-465-2111 E-mail Address: robbiebennett1505@att.net 2. Professional Engineer(PE) name: Miles A. Wright License number: 24934 Mailing address: 209 1st Ave South City: Conover State: NC Zip: 28613 Telephone number: 828-465-2205 E-mail Address: miles@wrightandassociates.us 'x 3. Licensed Soil Scientist(LSS)name: Caroline J. Edwards License number: 1220 Mailing address: 991 Duncan Road City: Rutherfordton State: NC Zip: 28139 Telephone number: 828-289-0122 E-mail Address: cjedwards234@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: 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 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 7. Property location (physical address,tax parcel identification number or subdivision lot, block number of the property to be permitted): Parcel ID# 374016824792 & 374020824491 NC DEPARTMENT OF HEALTH AND HUMAN SERVICES•DIVISION OF PUBLIC HEALTH LOCATION:5605 SIX FORKS RD,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 I AFFIRMATIVE ACTION EMPLOYER L , Engineer Option Permit Common Form LHD Reference: County Name: Catawba 8. Type of facility: ❑ Place of residence No. Bedrooms: No. Occupants: ® Place of business Basis for flow calculation: 10 Employees x 25 GPD =250 GPD 162 Seat Chapel X 3 GPD/Seat=486 GPD ❑ Place of public assembly Basis for flow calculation:Total=736 GPD 9. Factors that would affect the wastewater load: Additional Patrons over and above capacity 10. Type and location of proposed wastewater system: Expansion of the Facility; Additional Employees: Low Flow Plumbing Fixtures 11. Design wastewater flow: 736 gpd(For flow>3,000 gpd and industrial process,duplicate plans shall be sent to the State.) Design wastewater strength: M domestic ❑ high strength ❑ industrial process 12. A plat as defined in G.S. 130A-334(7a) is attached: ®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: a Yes ❑ No This is a saprolite system. ®Yes ❑ No 14. Evaluation(s)of soil conditions and site features in accordance with G.S. 130A-335(al)signed and sealed by a LSS is attached: ®Yes ❑ No 15. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes M NA 16. Proposed landscape,site,drainage,or soil modifications are attached: M Yes ❑ NA Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C 1, Miles A. Wright 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 . (e)(6). &3 .75---- 8/11/23 Signature of Licensed Prof na!Engineer Date esign ion of Registered Professional Engineer as legal representative of Owner for this Notice of Intent: 1, Rob;,' aBennett hereby designate Miles A. Wright ner Print Name of Registered Professional Engineer s m -Ai ,4;t.tiv- �ases of this Notice of Intent pursuant to G.S. 130A-336.1. 6.0 s Signature of Owner Date 0 ner 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 PART 3: Authorization to Operate(ATO) DHHS/EHS/OSWP-EDP COMMON FORM Updated July 2023 Page 2 of 3 Engineer Option Permit Common Form LHD Reference: The following items are included in this Authorization to Operate for an EOP: LHD USE ONLY: Initial submittal of request for ATO received: by Date Initials 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) ['Yes ❑ No 2. Operation and management program and ORC contract,if applicable ❑Yes ❑ No 3. Letter documenting Owner's acceptance of the system from the PE ❑Yes ❑ No 4. 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 ❑ No 7. Multi-party agreements required,as applicable, pursuant to 15A NCAC 18A. .1937(h) ❑Yes ❑ No If yes,agreements filed in County Register of Deeds in Deed Book Page Attestation by the Owner or the PE for Authorization to Operate 1 Miles A. Wright hereby attest that all items indicated above have been provided Print name of Owner or Professional Engineer and the system meets applicable federal,State, and local laws, regulations, rules, and ordinances in accordance with G.S. 130A-336-.1(e)(6). 8/11/23 Signature of Owner or Professional Engineer Date NOTES: LIABILITY: The Department, the Department's authorized agents,or local health departments shall hove no liability for wastewater systems designed,constructed,and installed pursuant to an Engineer Option Permit[G.S.130A-336.1(f)] DHHS/EHS/OSWP—EOP COMMON FORM Updated July 2023 Page 3 of 3 • Bennett Funeral Home Septic System Design Criteria Catawba County 21-Aug-23 area no. flow per employee flow/day per day employees 10 25 250 chapel 162 3 486 Total Flow 736 LTAR 0.4 gal/sf/day sf 1840 sf length 613.33 ft Equalization,trench length and dosing: Equalized Flow = 636 gpd LTAR = 0.4 gpd/sf Area of trench = 1590 sf Length of line = 530 ft 25% reduction length 398 ft(inflitrator or equal) Dose volume = 24 CF (70%of 4" line volume) 182 gallons Septic Tank Sizing = c} Volume = 1.170+500 Q = 636 gallons per day - Volume = 1244.12 gallon Use 1500 gallon Septic tank shall bear the NCDENR approval stamp WRIGHT and ASSOCIATES 4190 Hwy 16 South Newton, NC 28658 828 465 2205 office 828 465 5878 fax Page 1 of 1 recil@wrightandassociates.us Earthwise Designs Soils &Land Evaluation 7/17/23 SUPPLEMENTAL Site and Soil Evaluation OF REPAIR AREA Wastewater System Recommendation Bennett Funeral Services 7878 Hwy 16 Newton NC - Catawba County This report is submitted under the rule: 15A NCAC 18A .1971 ENGINEERED OPTION PERMIT PART 1: Submittal of Notice of Intent to Construct (NOI) Project: This report is to add area to the Repair area for the wastewater system for Bennett Funeral Services, due to construction of a new building. Wastewater strength: No change SYSTEM PROPOSAL: The design proposal is to increase the Repair drain field beside the current field; it will be gravity flow to a IIIg system with a 25% reduction in line length from typical. It will be a saprolite system. Part 1: Site features and geo-morphological description This site is located on a broad upland along the new Highway 16 on the east side of Newton. The slope ranges from 2 to 6 % with the aspect south to southwest. This supplemental Repair area is north of the facility and adjacent to the current wastewater system drain field. The Catawba County Soil Survey soil series which is mapped here is Lloyd loam; it is a very deep, well drained, moderately permeable soil found throughout the Southern Piedmont on uplands. The soils formed in residuum derived from intermediate and mafic, igneous and high-grade metamorphic rocks. 2 TAXONOMIC CLASS Pacolet: Fine, kaolinitic, thermic Rhodic Kanhapludults On this site it was found to be an eroded, deep, well-drained soil with sandy clay loam to clay loam subsoil. The subsoil has a low rock fragment content and few to common flakes of mica. Some small gravels were encountered. Shrink-swell potential is low and permeability is moderate to moderately high. Pit depths were more than 48 inches. The saprolite was evaluated as usable within the treatment zone. There were no redoximorphic mottles in the profiles. Two pits were evaluated for this report and are consistent with the original Repair area. See attached field sheet. The area is of Lloyd soil with a clay loam horizon and evaluated to be in the Group III category with a proposed LIAR of 0.40. The pits have soil depths and slopes to support a conventional drain field. By using a 25% reduction system (IIIg), space is available as shown on the Site Map to accommodate this change to the repair area. Part 2: Recommended depth for REPAIR Trench Bottom and System Design When the Repair Area is necessary: with a 3 foot wide IIIg system and an average slope of 3%, the recommendation is made to place the trench bottom at 20 inches. For line length, see Engineer's Report. Part 3: Other site-specific requirements for system design, installation, site preparation, modifications, and final landscaping The following recommendations are made: 1. Keep site disturbance to a minimum. 3 2. Regard installation, inspection of installation, and landscaping as one time unit. The field should be dressed immediately after installation and inspection and before any precipitation event. 3. Field should be landscaped to shed water. This would include leveling areas of sumps or bumps. There may be some topographic areas which will require additional sandy loam soil to aid the area in shedding water. 4. Pay special attention early on to settling, which may produce concave areas where additional soil has been added. Utilize sandy loam soil to fill any low places. 5. If soil is bare or has bare spots, seed and plant vegetation as soon as possible to encourage root growth and establish evapotranspiration. 6. The field will be maintained to reduce erosion, shed water, and insure a vegetative cover, with oversight by the soil scientist as needed. Curtain drains or surface diversions as needed will ensure stability of the surface and minimize surface runoff. The designer of the system may make other requirements. Please contact me for further information if needed. Sincerely, Caroline J. Edwards NC Licensed Soil Scientist#1220 S°EeelF,` Authorized On-site Wastewater Evaluator#10035E o%a 9 ' NC Land Application of Bio-Solids #10006173 4at11. SC Professional Soil Classifier#117 .Qc 1220 Attachments: Site Map -1 p. Soils Descriptions -1 p. Site Map to add Area Available: Repair Area see engineer's report Bennett Funeral Repair System:Gravity to IIIg Services Septic System N +Fepaaronds1'-.2' 1 [...i4l..:1::,::::r.v*I I: 1 s r I i! ! I s I . L_ ii r . 1 I i 11 BENNETT FUNERAL SERVICE /17/23 Earthwise Designs ,. 8289-01 22 Soils&Land Evaluation 8rd 234©gm �` C.1[dwards234�gmail.com P; et rill I ��I a Li F • 9 i Tar 1 , ,n� F, ll, F Ly V� — -It +- —---- -4- -•- - L6 Icp 1 It '..t 0. ten E.� I I�yI ^ R H 11I` L1!. 1 ii _ i � _ _ ___-,_._. . _ _ _.� L ± : I.__. . r l � . . E ..r 1. , � _ _.,__. _ ��_....__.. -. + �`�I L � , �° "__—. I t.' 1 , j I �" n Q gi0v _.a a 'ngf#� Imo' • ` z 1 00 tOc . . - .-_-_-__--__ I�i 1 ,. RA n 7C O 3 T,I w N - o • r f_._... r._ 1 o f O - C� �i 1I I rJ� �o -s 1 C ,r 7a+ I l i / f V 9 'q' V�1 , o P. _ I rl w F I 1 .-� ^� \\11 1° � �Cp _. _I �_._j 0. pr.: M 1 VI e '1 f < rMJ1 I II l' kl j 9 -' Intr. 1 2 i'-•ri-- , 1 Ifteti. a C‘ - ! _ ...,, lil 2 g " t A j . - y 1() 7: _ �,:,.. . , ,--•-_--.._._,-..�f,.__ ._. IS it AR o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/06/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC TE 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: Hiscox Inc. PHONE FAX 520 Madison Avenue E-MAIL/C,No.Ext): (888)202-3007 (A/C,No): 32nd Floor ADDRESS: contact@hiscox.com New York,New York 10022 INSURER(S)AFFORDING COVERAGE NAICx INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: Earthwise Designs INSURER C: 991 Duncan Rd Rutherfordton,NC 28139 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVQ POLICY NUMBER (MM/DDIYYYY)_,JMM/DD/YYYX1. LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RETED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) _$ 5,000 A P100.218.195.9 04/20/2023 04/20/2024 PERSONAL A ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JERT LOC PRODUCTS-COMP/OP AGG ,$ S/T Gen.Agg. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident)' $ AUTOS AUTOS NON-OWNED (Pe ROPERT DAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability P100.217.339.9 04/20/2023 04/20/2024 Each Claim:$2,000,000 Aggregate:$2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) CERTIFICATE HOLDER CANCELLATION Griffin Realty and Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I -- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDfYYYY) 08/14/2023 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 Scott Schweitzer NAME: SSIG(Scott Schweitzer Insurance Group) .(AHfc°.No.Ext), (704)856 3111 (nrc.Nor PO Box 473 E-MAIL tt sco .s ssi usm ADDRESS: G g .co " INSURER(S)AFFORDING COVERAGE NAIL# Denver NC 28037 INSURER A: ERIE INS EXCH 26271 INSURED INSURER B: ERIE INS CO 26263 Wright and Associates dba MW Engineering Inc. INSURER c: BEAZLEY INS CO INC 37540 209 1st Ave.S INSURER D INSURER E Conover NC 28613-2113 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM DDY/YYYYI (MMIDD11YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 �/ DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 2,000,000 _MED EXP(Any one person) $ 5,000 A Y Y Q97-2297341 04/04/2023 04/04/2024 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBI(EaNED accidentINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B X OWNED SCHEDULED AUTOS ONLY AUTOS Q04-0431285 04/04/2023 04/04/2024 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY (Per accident) $ X UMBRELLA UAB OCCUR EACH OCCURRENCE ' $ 1,000,000 B EXCESS LIAB 1 CLAIMS-MADE 028-0470431 04/04/2023 04/04/2024 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY B OFFICERJMEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVEANY Y� N I A 088-5400375 04/04/2023 04/04/2024 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) I I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Errors and Omissions C Y C20FAE220601 11/04/2022 11/04/2023 2,000,000 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Wright&Associates Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 209 1st Ave S THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Conover,NC 28613 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD