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1381 Cornatzer Rd OPERATION PERMIT or ice se ny P= Davie County Health Department *COP File Number, 198384-1 210 Hospital Street P.O.Box 848 County ID Number, Mocksville NC 27028 Evaluated For. REPAIR Phone:336-753-6780 Fax:336-753-1680 Township: EPhone#: her Horton Property Owner. Christopher Horton ornatzer Road Address: 1393 Cornatzer Road ille Cly: Mocksville 27028 :State/Zip: NC 27028 Phone#: ProperW Location & Site Information r1dress/Road#: Subdivision: Phase: Lot: 381 Cornatzer Road ocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 64 East left on Cornatzer Rd. on left across #of Bedrooms: Cornatzer Baptist Ch. before Milling Rd #of People: 'Water Supply: NIA *IP Issued by. *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert SaproliteSystem? ()Yes QNo Design Flow: 3 6 0 *Distribution Type: GRAVITY-SERIAL Pump Required? QYes QNo .Soil Application Rate: 0 - '1 *Pre Treatment: Drain field Ndrification Field 1 8 0 0 Sq.ft. 'System Type: INFILTRATOROUICK4STAND ARD No. Drain Lines 4 Installer: Randy Miser Total Trench Length: 4 5 0 ft. Certification#: 1128 Trench Spacing: _ 9 Inches O.C. Feet O.C. 'EH S: 2140-Nations,Robert Trench Width: _ 3 Qlnches Feet Date: 1 2 / 9 8 / 2 0 1 5 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Approval§tatus Inches Maximum Trench Depth: 3 6 Inches ® Approved Q Disapproved, Maximum Soil Cover: a 4 Inches CDP File Number 198384 - 1 Septic Tank County ID Number: Manufacturer. shoat Lat. STB: 760 Long; - Gallons: 1000 Installer: Randy Miller Certification#: 1128 Date: 0 8 / 0 8 / 2 0 1 5 *EHS: 2140•Nations.Robert *Filter Brand: POLYLOKPLA 22 With Pipe Adapter ST Marker: ❑ Yes E No Date: 1 2 / 0 8 / 2 0 1 5 Reinforced Tank: ❑ Yes No Approval Status 1 Piece Tank: ❑ Yes ® No _® Approved❑ Dlsaproved Pump Tank Manufacturer. Installer. PT: Certification#: Gallons: *EHS: Date: / / Date: / RiserSealed ❑ Yes ❑ No RiserHeght: [IYes ElNo (Min.6 in.) Disapproved Reinforced Tank: ❑ Yes ElNO APP +aIStatus ❑ i4pproved❑ 1 Piece Tank: ❑ Yes ❑ No Supply Line Pipe Size: inch diameter Installer Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status �❑ Approved❑ Dlsapproyed PuMp ggqul[Qment PumpType: Installer. Dosing Volume: - Gal Certification#: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check-valve ❑ Yes ❑ No Apjiroval Status PVC unions [IYes ElNo El Approved❑ Disapproved Vent Hole ❑ Yes ❑ NO Anti-siphon Hole ❑ Yes 0 No EDP Fite Number 198384 - 1 County ID Number: Electric Equipment NEMA 4X Box or Equivalent El Yes ❑ No Installer. Box 12 inches Above Grade El Yes El No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ NO *ENS: Pump M an ually 0 perable ❑ Yes ❑ No *Activation Method: Date: 'Approval Status Alarm Audible ❑ Yes ❑ No p Approved❑ Disapproved. . Alarm Visible ❑ Yes ❑ No , 2140-Nations,Robert *Operation Permit completed by: Authorized State Agent: Date of Issue: 1 a / 0 8 / a 0 1 5 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for _ Sewage Treatment and Disposal, 15A NCAC 18A .1900 et. Seq.,and as conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE IM sewage septic system. Rule .1961 requires that a Type TYPE II A, septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator. N/A Reporting Frequency By Certified Operator. NIA Rule .1961 requires that a Type IV and V septic systems designed fora hometbusiness owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (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 certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing 41mport Drawing **Site Plan/Drawing attached.** ' OPERATION PERMIT 198384 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box W County File Number: Mocksville NC 27028 Date: O Inch Drawing Drawing Type: Operation Permit Scale: . OsOH A k iv q I I i Sli CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 198384- 1 Davie County Health Department County ID Number: 210 Hospital Street Evaluated For: REPAIR P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 1 1 / 1 7 a 0 a 0 —7 Applicant: Christopher Horton Property Owner: Christopher Horton Address: 1393 Comatzer Road Address: 1393 Comatzer Road City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 1381 Comatzer Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 64 East left on Cornatzer Rd. on left across Cornatzer Baptist Ch. before Milling Rd #of Bedrooms: #of People: *Water Supply: N/A System Specifications Minimum Trench Depth: a 4 CF[ow: Ps shallow Placement Inches Minimum Soil Cover: O Yes �1 No 1 a Inches 3 6 0 Maximum Trench Depth: a 4 Inches Soil Application Rate: 0 . a Maximum Soil Cover: 1 a Inches *System Classification/Description: *Distribution Type: GRAVITY-PARALLEL(eq.d-box) TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: QYes ONo O May Be Required Nitrification Field 1 8 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 5 1-Piece: QYes ONo Total Trench Length: 4 5 0 ft GPM--vs– ft. TDH Trench Spacing: Inches O.C. – 9 Feet O.C. Dosing Volume: Gallons Trench Width: – 3 O Inches ® AFeet Grease Trap: Gallons inches Pre-Treatment: O NSF OTS-1 OTS-11 Aggregate Depth: Septic Tank Installer Grade Level Required: 01011 O 111 ON Page 1 of 3 CDP File Number 198384 - 1 County ID Number: ' ❑ Open Pump System Sheet Repair System Required:®Yes O No ONO, but has Available Space CDesign System Inches O. . Trench Spacing: 9 O fication: PS Shallow Placement — ®Feet O.C. Trench Width: O Inches w: 3 6 0 — 3 ®Feet Soil Application Rate: Aggregate Depth: inches .� Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: 1 a LESS) Inches Maximum Trench Depth: a 4 *Proposed System: 25%REDUCTION Inches Maximum Soil Cover: 1 a Nitrification Field 1 8 0 Inches Sq.ft. No. Drain Lines 6 *Distribution Type: GRAVITY-PARALLEL(eq.d-box) Total Trench Length: 4 5 0 ft Pump Required: OYes O No O May Be Required Pre-Treatment: O NSF OTS-I OTS-II ".") *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Characters maining 750 *Permit Conditions 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. CRemaining haracters 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been completed during the period of validity of the Construction Permit,the Information submitted in the application for a permit or Construction Authorization Is found to have been incorrect,falsified or changed,or the site Is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(A 937(g)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature, Date: *Issued By: 2140-Nations,Robert Date of Issue: 1 1 / 1 7 / a 0 1 5 Authorized State Agent: Malfunction Log OYes ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 • CONSTRUCTION AUTHORIZATION 198384 - 1 • Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 11 / 17 / 2015 O Inch Drawing Drawing Type: Construction Authorization Scale: , O Block O N/A _ - I I ----- -------- -----;------ ---- -- ---- --------- ---. _... ---- ------- -------------------------- ------------- ---...._...---------- i ti i � i I i i Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street l File Number: 198384 - 1 Q 0 �� P.O.Box 848 Mocksville NC 27028 County File Number: o� Date: .1.1 / 17 / a 0 15 S [� � Click belo to import an image fr an external location: Drawing Type:Construction Authorization 00 1 -7/ � d 9� V` Vv OD n V. s s Page 3 of 3 P1 P2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION 11ch(dophe'l 040d I 3S1 co r1u0j2,.6,b 3 Nroodl'ob 01 1 , 32 Ae, &ad# P �0-000-00&5-- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 .7 Landscape position i I 7 �k i,,LI Slope% HORIZON I DEPTH - - 72- Texture group C S1I 5 Consistence 5 F vv; S P i Structure g� pL_ FL SEW - Mineralogy (' EXP 5" HORIZON II DEPTH I -t IQ, fo' It, Texture group Consistence SS vFt Ss SP S5 P Fi S P• FFz 55 5P Structure C9 0- 1 C47- Mineralogy5 f E�P y 5£y V HORIZON III DEPTH Texture group Consistence 5 Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE ' ► ' tu CLASSIFICATION tlLA5 P S LONG-TERM ACCEPTANCE RATE 3 Z SITE CLASSIFICATION: EVALUATION BY:� 144Ch 611 IPOP.AAWi LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: T_d REMARKS: LEGEND Landscape Position R-Ridge S -Shoulder L-Linear slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S -Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SI.0-Silty clay C-Clay S'ON4IS ,N .E - Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm . EFI-.Extremely firm 3Y&I NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very.plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Nsites • Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate- eal/davM2 rururi ncmc ine.A.eai ■■a■/■■e■■e■■e�■e■e■■■■e■■■/e■■■■■■�■ecce■■■■■■■■■■■■■■■■■■■■■■e■/■■■e■■■■■e■/■e■e■■ ■�■■■■//■■■■■ee■e■■■■■■■■■■■■■■■■■e■■eee■■■■■■�■■�■■■■■■■■■e■/■■■■■■■e■e■■■/■■■e■■■■ ■■ee■■■■■■■■e■■■�■■■■�■■■■■■■■■■■I■■■■/■e■■eeeee■■■e■■■e■■■■e■/■e■e■e■■e■e■■■■e■■■■■■ ■■�■/■■�e■■■■�■■■■/■ee■ee/■e■■e■e�>te■■e■e■ 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Zj 7061 Roil 52 (15 L (1,1�1 i �f f i s 1 j A 13.81 Ol i Q� v s; ty 4 t `i yL L` ky a c� Lahitude 354 55 22.32 Longitude:'-804 26` 56,67' ......_. http://maps2.roktech.net/davie_gomaps/index.html 11/16/2015 ! L rf �r J ff J Jr 3 f r rf 7 3B1 J �3 I is r . ' 5 q 706 52 CY) 50 ) 5 � 5 t , 5 t �l t. t t ~t ti I z7 �� aPie�� Wd no U t1'S s Printed:Nov 16, 2015 All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this website.