251 Brier Creek Rd (2)OPERATION PERMIT or ice se n v
Davie County Health Department `CD RIe Number 233060-1
210 Hospital Street
P.O. Box 848 County ID Number:
Mocksville NC 27028 Evaluated For: EXPANSION
Phone 331S-753-6780 Fax 336-753-1680 AITownship:
Applicant: Terry A Junko Gilbert Property Owner: Terry A Junko Gilbert
Address: 149 Whitehead Drive Address: 149 Whitehead Drive
City: Advance I City: Advance
State/Zip: NC
27006
PIE
tate/Zip: NC 27006
Phone#: (336)]94-65]0
hone#: (336)]94-65]0
J
Property
Location & Site Information
Atltlress/Road4
Subdivision:
Green Brier Phase: Lot
251 Brier Creek Road
Advance NC
27006
Directions
Hwy 64 east, left on Fork Bixby Rd. appmx., 5 miles,
Structure: SINGLE
FAMILY
left on Green Brier Rd.
4 of Bedrooms: 3
4 of People: 3
`Water Supply: PUBLIC
`IP Issuetl by:
`System Olassl6catlon/Descrlptlon:
TYPE III G. OTHER NON CONV. TRENCH SYSTEMS
`OA issued by: 2140-Netb�,
Roben
Seprollte System? OVes ®No
D gnHow:
3 6 0
`Distribution Type: GRAVITYSERIALPwR�lm49
No
Sou Application Rate: 0
a
`Pre -Treatment
Drain field
Nitrification Field
6
0 0
Sq.fl. 'System Type: INFILTRATOR Ol11CR4STANOARO
No. Drain Lines
3
Installer: Bran WEaniel
Total Trench Length:
1 5
0
ft
Cemnaation #: 1118
Spacing:
_
O gFee
®Feet
Oo.c.
InchTrench
O. C. `FHS: 2140 Ll Roben
Trench Width;
_
3 Omcbes
®Feet
Date: 0 a/ a 3/ a 0 1 7
Aggregate Depth:
Inches
Minimum Trench Depth:
3 6
Inches
Minimum Soil Cover:
a 44
Inches
Approval Status
Maximum Trench Depth:
3 6
M Approved El Disapproved
Inches
Maximum Soil Cover:
a 4
Inches
Page f of
CDP File Number 233060
- 1
County ID Number.
Septic Tank
Manufacturer:
Lat.
'
Long:
STB:
Gallons:
Installer:
Certification #:
Date: /
/
`EHS:
`Filter Brand
ST Marker: p Yes
❑
No
Date:
ReinforcedTank: p Yes
❑
No
pproval Status
proved El Disapproved
f Piece Tank: ❑Yes
❑
No
Pump Tank
Manufacturer:
Installer:
PT:
Certification #:
Gallons:
`EHS:
Date: /
/
Date:
Riser Sealed ❑ Yes
❑
No
Riser Height: ❑ Yes
❑
No
(Min.
B in.)
Reinforced Tank: ❑ Yes
❑
No
IPiece Tank: ❑ Yes
❑
No
Supply Line
Pipe Size:
inch diameter
Installer:
Pipe Length:
feet
Cenricatlon#:
`EHS:
`Schedule:
Pressure Rated ❑ Yes
p
No
Date:
Approved Linings p Yes
p
No
Approval Status
❑
Approved Ll Disapproved
Pump Requirement
Pump Type:
Installer:
Dosing Volume:
Gal Certification #:
Draw Down:
Inches
`EHS:
`Chain:
Date:
_
Valves Accessible ❑Yes
❑
No
Flow Adjustment Valve ❑
Yes
p
No
Check -valve p
Yes
❑
No
Approval Status
PVC Unions p
Yes
p
No
p Approved El Disappmv
Vent Hole p
Yes
❑
No
Anti -siphon Hole p
Yes
❑
No
Page 2 of 4
CDP File Number 233060 - 1 County ID Number.
NEMA4X Box or Equivalent
0
Yes
❑
No
Installer:
Box 12 Inches Above Grade
❑
Yes
❑
No
Certifmarion #:
Box Adj. To Pump Tank
❑
Yes
[INo
Conduit Sealed
❑
Yes
❑
No
`EHS:
Pump Manually Operable
❑
Yes
❑
No
`Activation Method
Date:
Alarm Rumble EE
Yes LlNo
Alarm Visible ❑ YES ❑ No
zlao-Neuarvc, RaLen
`Operation Permit completed by
Authorized State n Date of ssue: 0 a/ a 3/ 2 0 1 7
Owner/Applicant Signa ure:
This system has been installed In compliance with applicable NO General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NOAO 18A.1900 et Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE III c. Sewage septic system.
Rule.1861 requires that a Type NEE IIIc septic system meet the following criteria:
Minimum System Review By The Local Health Department: WA
..--------- 1_.:... OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Cerllfaed Operator: WA
Rule.1861 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract
Rath a public management entity with a certified operator ora private derlltled operator for the life of the septic system.
Rule.1861 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a
public management entity with a cent ed operator for the life of the septic system.
Rule. 1881 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system owner and chilies of the owner
and same.system operator,
prshall visionequrespecific contract requirements i for maintenance and
operation, reeponandolthofrheownerantlsystemsoperator,per performance
thecontract
system.
be Ineffect for ae long eerhe
system Is Inuse,antl otherrequirementso for the thecontinued
systems
rute such
aceofrhe system. Ir shell also beacondition of
the Operation Permit that subsequent owners of the systems execute such a contract.
®Hand Drawing DImportDrawing
"Site Plan/Drawing attached."
Page 3 of 4
OPERATION PERMIT
Davie County Health Department
210 Hospital street
P O. Bax 808
Mackrvllle NC 21028
Dry Drawing Type. Operation Permit
CDP File Number. 233060 - 1
County File Number.
Date./�_/�,
OInch
Scale. OBlock-,_,bdR.
Orl
Page 4 of P1 P2 P3
OPERATION PERMIT
oeNe Cauray Health Department
210 Hospital Street CDP File Number.
P O. Bl 808
Nlockavllle NC M28 County File Number.
Date.
Click below, to import an image from an external location: Drawing Type'. Operation Permit
Page4 of4 P1 P2 P3
Drain Field. System Final Inspection Loa: -
4000
Septic Tank.
4000
Pump Tank.
4000
Supply Line.
4000
Pump Requirements.
4000
Electrical Equipment. - =
4000
P1 P2 P3