HomeMy WebLinkAboutEOP-10-2023-206509.tif COP-/D )3 '20052fi
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,,, �%� ROY COOPER •Governor
� •,,' •, :. NC DEPARTMENT OF KODY H. KINSLEY•Secretary
l HEALTH AND
14� '` HUMAN SERVICES MARK BENTON • Deputy Secretary for Health
Jr'7
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: id— ! — 2� by `!-
Date Initials
PART 1: Notice of Intent to Construct(NOI)-Please check all that apply
❑X Single System or ❑ Multiple Systems
AND
E 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.):
Silverado Trail, LLC
Mailing address: 161 US Hwy 70 SE City: Hickory State: NC Zip: 28602
Telephone number: (828)381-9587 E-mail Address: dave@everettchevy.com
2. Professional Engineer(PE) name: Daniel Shabeldeen License number: 029232
Mailing address: 3145 Tate Blvd.SE City: Hickory State: NC Zip: 28602
Telephone number: (828)320-7252 E-mail Address: dan@shabeldeen-engineering.com
3. Licensed Soil Scientist(LSS) name: Connie Adams License number: 1186
Mailing address: P.O. Box 2175 City: Indian Trail State: NC Zip: 28079
Telephone number: (828)234-3776 E-mail Address: connieadamsIss@gmail.com
4. Licensed Geologist(LG)(if applicable) name: N/A License number:
Mailing address: City: State: Zip:
Telephone number: E-mail Address:
5. On-Site Wastewater Contractor name: Max's Digging Service License number: 1127
Mailing address: 1972 Adam St. City: Conover State: NC Zip: 28613
Telephone number: _(828)596-6040 _ E-mail Address: millerbj@gmail.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:
17 PE n LSS ❑ LG n On-site Wastewater Contractor
7. Property location (physical address,tax parcel identification number or subdivision lot, block number of the
property to be permitted): PIN 3705 1961 1288
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/AFFIRMATIVE ACTION EMPLOYER
Engineer Option Permit Common Form LHD Reference: C.-bP to•x)3 )Dl,50
County Name: Catawba
8. Type of facility: ❑X Place of residence No. Bedrooms: 6 No.Occupants:
n Place of business Basis for flow calculation:
❑ Place of public assembly Basis for flow calculation:
9. Factors that would affect the wastewater load: Domestic wastewater
10. Type and location of proposed wastewater system: Location as shown;Type Illg w/25%reduction
11. Design wastewater flow: 720 gpd(For flow>3,000 gpd and industrial process,duplicate plans shall be sent to the State.)
Design wastewater strength: X❑domestic n 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: ❑X Yes ❑ No
This is a saprolite system. 0 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: n Yes ❑ No
15. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes ❑X NA
16. Proposed landscape,site,drainage,or soil modifications are attached: 0 Yes L NA
Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C
I, Daniel Shabeldeen 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).
10/9/2023
Signature of Licensed Professional Engineer Date
Designation of Registered Professional Engineer as legal representative of Owner for this Notice of Intent:
David Kent Everett hereby designate Daniel Shabeldeen
Print Name of Owner Print Name of Registered Professional Engineer
as my legal re enta 've for purpo es o his otice of Intent pursuant to G.S. 13 A,- 36.1.
Signature of 0 r 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 Dote
PART 3: Authorization to Operate(ATO)
OHHS/EH5/OSWP—EOP 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) n Yes n 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
I, 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).
Signature of Owner or Professional Engineer 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)]
DHHS/EHS/OSWP—EOP COMMON FORM Updated July 2023 Page 3 of 3
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SHABELDEEN ENGINEERING, PA
3145 TATE BLVD. SE• BOXA • HICKORY, NC • 28602 PHONE:(828)320-7252
CIVILMVATER/SEWER/ENVIRONMENTAL FAX: (828)394-4126
CONSTRUCTION MANAGEMENT dan@shabeldeen-engineering.corn
October 9, 2023
Mr. Robbie Phelps
Catawba County Environmental Health
P.O. Box 389
Newton, NC 28658
SUBJECT: Engineered Option Permit Submittal
3921 6th St. Dr.; Hickory, NC 28601
PIN: 3705-1961-1288
Mr. Phelps:
On behalf of the Silverado Trail, LLC (Owner), Shabeldeen Engineering, PA (SEPA) is
submitting the following items for an Engineered Option Permit.
1. Application for Environmental Health Services
2. Notice of Intent (NOI)
3. Soils Evaluation by Ms. Connie Adams, LSS
4. Septic System Plan (dated October 9, 2023)
5. Proof of insurance PE and Max's Digging Service, Inc(contractor)
Project Description
The Owner recently purchased the 13.65-acre parcel with an unfinished house. The county
issued an Authorization to Construct (AUTH-2019-118709) a gravity system for the original four
(4) bedroom structure with a basement. The approved septic system has never been installed.
The Owner plans to increase the number of bedrooms to six (6) and construct an addition
that will sit on the location of the approved septic system. This EOP provides the design of
a new system to accommodate the addition flow in a new location.
Ms. Connie Adams, LSS conducted the soils evaluation. Based on the evaluation, the septic
system will be a gravity Type Illg system consisting of the following major components:
1. 1,500-gal. pre-cast concrete septic tank
2. Five (5) rows of graveless chambers ranging between 102LF and 106LF for a 25%
reduction.
As shown on the plans, the septic system will be setback 15 feet from the house structure and
10 feet (minimum) from the property line. A 5-hole distribution box will distribute effluent to the
drainlines installed along contour, 9-feet on center. The repair area will be located below the
initial drainfield.
I appreciate your assistance. Please do not hesitate to contact me if you have any questions.
EC RO‘> Sincerely,
SEAL k
029232 z
9 Daniel Shabeldeen, P.E.
rst o '` 10/9/2023
�FC SHgac:,'Pi
SHABELDEEN
h _ ENGINEERING
Septic System Soil Investigation and Proposal
Prepared for Silverado Trail LLC
By Constance M. Adams, LSS
Site: 3921 6th Street Drive NW, Hickory, NC
PIN 3705-1961-1288
Catawba County, NC
9S
Proposed development: 6 bedroom house
Total Design Daily Flow: 72o gallons per day(gpd)
Repair area. required6-77i l (":")
Septic tank size: 150o gallons minimum
P F ;•
Initial System(soil pits 1,5, and 7—see pp 4 and 5) •
Soil depth: 32"->44"
Depth to unsuitable horizon: 40"->48"
Slope: 1a-12%
Overall Long-term acceptance rate: .35 gallons per day/square foot trench bottom(GPD/sf)
Proposed system type: 25% reduction
Recommended trench width: 36"
Recommended trench depth: 19" (21" maximum)
Total trench length: 518 feet on 9 foot centers
Comment: Location of the initial drainfield is as shown on the Overall Site Map (Map 1, page
2). Within this area 518 feet of line have been laid out as shown on Drainfield Area Detail Map
(Map 2,page 3). Lines range from 102' to io6'. Flow should be split into 5 equal parts using a
distribution box, with one part going to each line.
No effluent pump will be needed. This is a type IIIg system.
This is a saprolite system. Any wells should be located a minimum of too'from any part of the
septic system.
Repair area(soil pits 6-8—see p 5)
Soil depth: 31"-38"
Depth to unsuitable horizon: 31"->48"
Slope: 10-12%
Overall Long-term acceptance rate: .35 gallons per day/square foot trench bottom (GPD/sf)
Proposed system type: 25% reduction
Recommended trench width: 36"
Recommended trench depth: 14"
Total trench length required: 518 feet on 9 foot centers
Comment: Repair area has space for four 130-15o foot lines as shown on Map 2 (see p 3).
Pg 1 of 5
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Map 2: Drainfield Area Detail Map Prepared for: Silverado Trail LLC
Site: 3921 6th Street Drive NW, Hickory,NC Prepared by: Constance M Adams, LSSPage 3 of S
Date: 9/24/2023 Scale 1"=50'
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PARTMENT OF HEALTH AND HUMAN SERVICES Jim ' .m__
VISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID 4.3105-1i6(-I2
-SITE WATER PROTECTION BRANCH COUNTY. CgtRWbq
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
-WNER: St 1V-e�Cc 4 Tea 1 1 LL-C APPLICATION DATE
DDRESS: _ DATE EVALUATED: _,]
+
ROPOSED FACILITY: L PROPOSED DESIGN FLOW(.1949): )2...6 PROPERTY SIZE: 13 Ac .
OCATION OF SITE: ,39 2.1 (,,-+1'' -h-I)r NW , N;c k-oti ,.L.K. PROPERTY RECORDED:
LATER SUPPLY: :1 Private X Public , . Well -Spring ..j Other
VALUATION METHOD: L ,Auer Boring, X Pit Cut TYPE OF WASTEWATER: ){Sewage Industrial Process Mired
• 4,
P
a SOIL MOIMIOLOGY OTHER
F
F (.1941) -- PROFILE FACTORS
I .1940
LANDSCAPE HORIZON
POSITION/ DEPTH PROFILE
k SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS
SOIL
STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPR RESTR <AR
TEXT(iRE MINERALOGY COLOR DEPTH 0 HORIZ
CLASS
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DESCRIPTION INII IAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
Available Space( 1945) V \/
/ SITE CLASSIFICATION (.1948): _P5
�
EVALUATED BY: r. , Aok04 5__
,a stern T}'pe(s) 25 7a Per 25�a j.' OTHER(S)PRESENT: _--)an nLct I -LPP►t bar Lkn( 7n1/ i1,ii-er
, :TAR 0,35 b,35
•C1 `,i -NTS
Updated February 2014
SOIL/SITE EVALUATION Sheet _�of .
(Continuation Sheet-Complete all field in fulli
DEPARTMENT OF HEALTH AND HUMAN SERVICES PROPERTY ID#:37o -1961-12..88
DIVISION OF PUBLIC HEALTH DATE OF EVALUATION: 1(16 J L 2.3
ENVIRONMENTAL HEALTH SECTION COUNTY: Catawbq
ON-SITE WATER PROTECTION BRANCH
i i . • .
P
R SOIL MORPHOLOGY OTHER
0
F (.1941) PROFILE FACTORS
1 .1940
E LANDSCAPE HORIZ .1942
POSITION! .1941 .1941 SOIL .1943 .1956 .1944 PROFILE
ON p SLOPE /o DEPTH STRUCTURE! CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR CLASS
(IN ) TEXTURE MINERALOGY' COLOR DEPTH CLASS HORIZ <AR
1 L k11 L
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COMMENTS:
`
Updated February 2014