The URL can be used to link to this page

1420 Deadmon Rd OPERATION PERMIT or ice use Only Davie County Health Department *CDP File Number 161516-1 210 Hospital Street L6-o0o-00-034 f County ID Number: P.O.Box 848 ty Mocksville NC 27028 Evaluated For: REPAIR Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Doug Wall Property Owner: Doug Wall Address: 1420 Deadmon Rd Address: 1420 Deadmon Rd CRY: Mocksville City: Mocksville StatefZip: NC 27028 StatefLip: NC 27028 Phone#: (336)940-7553 Phone#: (336)940-7553 PropertV Location & Site Information rAddresslRoad#: Subdivision: Phase: Lot: 1420 Deadmon Rd Mocksville NC 27028 Directions Structure: SINGLE FAMILY 601 South past Davie High, turn left. Home on right #of Bedrooms: 3 #of People: 'Water Supply: PUBLIC *IP Issued by: *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? Q Yes Q No Design Flow: 3 6 0 * GRAVITY-SERIAL Pump Required? Distribution Type: QYes (QNo Soil Application Rate: 0 a 7 5 *Pre-Treatment: Drain field rNo. cation Field 1 3 0 9 Sq. ft. *System Type: INFILTRATOR QUICK 4STANDAR D rain Lines 1 Installer: ben crotts Total Trench Length: a 0 0 It. Certification#: Trench Spacing: — 8lnches O.C. Feet O.C. EHS: 2140-Nations,Robert Inches Trench Width: Feet Date: 1 1 / .2 5 / a 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Approval Status Maximum Trench Depth: 3 6 Inches _y El Approved 0 Disapproved Maximum Soil Cover: 1 a Inches CDP File-Number 161516 - 1 Septic Tank County ID Number: L6-000-oo-o34 Manufacturer. Lat. Long: STB: - Gallons: Installer: Date: j j Certification#: 'EHS: *Filter Brand: ST Marker: ❑ Yes ❑ NO Date: Reinforced Tank: [J Yes El No Status No ❑ Approved❑ Disapproved 1 Piece Tank: El Yes ❑ NO Pump Tank Manufacturer. Installer: PT: Certification#: Gallons: 'EHS: Date: j j Date: RiserSealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ NO (Min.6 in.) Approval Status ein�Piem ank: ❑ Yes ❑ No ❑ Approved❑ Disapproved 1nk: E3 Yes ❑ NO Supply Line CPipe Size: inch diameter Installer: Pipe Length: feet Certification#: 'Schedule: 'EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ NO Approval Status ❑ Approved❑ Disapproved Pump Requirement ( Pump Type: Installer: Dosing Volume: - Gal Certification#: Draw Down: Inches 'EHS: *Chain: f j Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Status PVC unions ❑ Yes ❑ No ❑ Approved❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes 0 No CDP File Number 161516 - 1 County ID Number: 1.6-000-00-034 Electric Equipment NEMA4X Box or Equivalent p Yes El No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'EHS: Pump Manually Operable ❑ 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 1 / 0- 5 / 0- 0 1 4 This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 1B .1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE ii A. sewage septic system. Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria: Minimum System Review By The Local Health Department: N/A Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator: N/A Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the 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 for maintenance 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. OHand Drawing Olmport Drawing **Site Plan/Drawing attached:k* • OPERATION PERMIT Davie County Health Department CDP File Number: 161516 - 1 210 Hospital Street W-000-00.034 P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Operation Permit Scale: QBlock QNJA _ 1 j S i i V I jS. 1 CONSTRUCTION For Office Use Only AUTHORIZATION 'CDP File Number 161516-1 = Davie County Health Department p County ID Number: L6-000-00-034 4 '>. • 210 Hospital Street f Evaluated For: REPAIR V r P.O.Box 848 �� vim.. gc�tved Township: Mocksville N 7028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 1 0 / a 7 a 0 1 9 Appli cant: Doug Wall Property Owner: Doug Wall Adp lldress: 1420 Deadmon Rd Address: 1420 Deadmon Rd CRY: Mocksville City: Mocksville State2ip: NC 27028 State2ip: NC 27028 Phone#: (336)940-7553 Phone#: (336)940-7553 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 1420 Deadmon Rd Mocksville NC 27028 Directions Structure: SINGLE FAMILY 601 South past Davie High, turn left. Home on right #of Bedrooms: 3 #of People: 'Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 CFlow: Provisionally Suitable Inches Minimum Soil Cover. 1 a OYes @No Inches 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - a 7 5 Maximum Soil Cover: a 4 Inches 'System Classification/Description: "Distribution Type: GRAVITY-SERIAL TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: _ Gallons 'Proposed System: 25%REDUCTION 1-Piece: OYes ONo Pump Required: ()Yes ONo ()May Be Required Nitrification Field 1 3 0 9 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1-Piece: OYes ONo Total Trench Length: 3 a 7 ft GPM vs— ft. TDH Trench Spacing: _ 9 Oinches O.0Q* Feet O.C. . Dosing Volume: _ Gallons Trench Width: Inches 3 _ gFeet Grease Trap: LGallonsAggregate Depth: inches Pre-Treatment: ONSF OTS-1S-IISeptic Tank Installer Grade Level Required: O1 ()11 0111 Page 1 of 3 CDP File,Number 161516 - 1 County ID Number: 1-6-000-00-034 ❑ Open Pump System Sheet Repair System Required:OYes ONO ONO, but has Available Space rDesign System Trench Spacing: Inches O.C. ification: Feet 0.C. Trench Width: Q Inches w: _ o Feet Soil Application Rate: Aggregate Depth: inches 'System Classification/Description: Minimum Trench Depth: Inches Minimum Soil Cover. Inches 'Proposed System: Maximum Trench Depth: Inches Maximum Soil Cover: Nitrification Field Inches Sq. ft. No. Drain Lines 'Distribution Type: Total Trench Length: ft Pump Required: OYes ONo OMay Be Required Pre-Treatment: ONSF OTS-1 OTS-11 "Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7 "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. Check the outlet of the tank and distribution box to ensure lines are being fed.If existing system is still functioning,add 100 foot less new system. This Authorization for Wastewater System Construction shall bevalid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued atthe sametime the Improvement Permit Issued(NCGS 130A-33G(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 besuspended or revoked(.1937(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 Applicariftegal Reps. Signature: _ Date: "Issued By: 2140-Nations,Robert Date of Issue: 1 0 a 7 a 0 1 4 Authorized State Agent: Malfunction Log Oyes @Hand Drawing 0lmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 • CONSTRUCTION AUTHORIZATION 161516 - 1 Davie County Health Department CDP File Number: • 210 Hospital Street County File Number: 1-6-000-00-034 P.O.Box 848 Mocksville NC 27028 Date: 1 0 / 2 7 / 2 0 1 4 Olnch Drawing Drawing Type: Construction Authorization Scale: . ON/ABlock ft. , n ' f c Paae 3 of 3 DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR n F Name WoAPPLICATION Number qq'o- Address tJ i (,(e- Mailing Address (if different from above) Email Address: Subdivision Name Lot# Directions S d l�Yl 'Q Date System Installed Name System Installed Under Type Facility Number Bedrooms_ Number People Served Typ Water Supply Specific Problem Occurring Wien I ien lel Date Requested Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE,AND THAT I UNDERSTAND T T I RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date /19L—.27—/ RIIHS Revisit Charge Date Reason Revised 2-2011 /6/b A0 DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR Name ',Telephone Number Address Uzo Q Mailing Address (if different from-above) Email Address: o�, Subdivision Name Lot# Directions ( l�l'1 Date System Installed 1q1 UglyName System Installed Under Type Facility Number Bedrooms_ Number'People Served Typ Water Supply (20J J �j r Specific Problem Occurring Date Requested Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE;AND THAT I UNDERSTAND THAT, I Ay RESPONSIBLE FOR ALL CHARGES INCURRED. FROM THIS APPLICATION Signature of owner or Autho izze' Agent Initial Fee Date M r J.7 HS Revisit Charge Date Reason Revised 2-2011 Appraisal tCard Page 1 of 1 DAVIE COUNTY NC 10/27/20140:53:00 AM ALL EARL DOUGLAS WALL DAIS 6 Retem/Appeal Notes: Parcel,L1-000-00-031 120 DEADMON RD PIAT:/ UNIQ ID 22167 6372000 D331-PIG ID NO:5756587209 DWntl:WALL EARL DOUGLAS COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1 wal Year.2013 To' Yor:2015 1 LOT DEADMON RD 5.680 AC SRC.Inspemon raised or 19 en S O 20 2008 05004 FAIRFIELD TW-05 !Y- III E%- AT- UST ACTION 20110712 CONSTRUCTION DETAIL MARKET VALUE DEF0.ECIATION CORRELATION OF VALUE n tbn• Standard 1.2500 ED. 615E uO Fbor System•• USE 00 Area U RATE I RCN EYE AYB CREDENCE TO MARKET I ood 0.0 01 01 1,905 0 101 72.80 11093119081978 %GOOD [15.0 DEPR.BUILDING VALUE-CARD 105,70 zterlor Wallt-3 luminum In I Sldin 29.0 TYPE:Single Family Residential Single Family Residential MARKET LAND VALUE•CARD 19,56 oo0nq St—ure•03 STYLE:5-Ranh W/basement TOTAL MARKET VALUE-CARD 162,51 al oo0nq Cover-03 ntMor Wall ConslruRbn-5 OTAL APPRAISEDVALUE-CARD 162,54 all Sheetmck 20.0 OTAL APPRAISED VALUE-PARCEL 162,51 nbdor Floor Cover•OB heel Vln eminate 6.0 nNdor Floor Cover•11 OTAL PRESENT USE VALUE-PARCEL OTAL VALUE DEFERRED-PARCEL eating Fuel-04 OTAL TAXABLE VALUE-PARCEL 162,54 uIngType-10 +__.3a•'--+ eat Pum 4.0 IU•M I PRIOR Ir Cond0bninq Type-03 1 I UILDING VALUE 109,7] ntral I I MF VALUE 8,38 AmyBaNroomVH4H- 2 Z D VALUE 49,56 e t 0.ESENT USE VALUE throgms I I IEFERRED VALUE 00 I II edrooms I 23____; 2 S- Fa FUS•0LL•0 alf-Ballrooms AS•OFUS•OLL•0 +••-ZO--•# PERM IT Rice [ [ s- 1 1 ANU.5ER AMOUNT OTAL POINT VALUE 00.00 BUILDING ADIU MF TS I [ _II4--•20---+ ++---20---4 OUT:WTRSHD: ha Dei n FACTOR 4 1.050 I N A$ I F C P I SAL A A I I I FF. OTAL ADIUSTNENT FACTOR 1.01 I I I "COR D ATE DEED NDIGTEtAL OTA.QUALITY INDEX 1 I I I 'Pe PRIC .2 •2 3 0103 551 1]99 WD X I I • I I I I I I [ I I ;___23--------20.......20•-.+ I F O P I HEATED AREA 1,524 t • +...._.-10 •-•____# NOTES OGS SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR TYPE GS AREA % RPL CS ODE ESC0.IFR0 OU.11T M N RICE NI BLDGi A B ATE OND ALU 0 17 1 MED 2 12 28 5.1 1 _ 190 199 5 7 CP 56 02 10192 9 ETAL BLDG 2 26 52 15A 01 03 5 720 OP 32 03 0151 OTA.... B%FVALUE 20 EM 1 -441 REPLACE 3 1"ory 2,25 Sln le UBAREA 3,01 10,931 DIALS UILDING DIMENSIONS FCF=W20EAS-W31416W20516W20520 E23FOP-SBNONBWI0E20N28 52BE20N26 PTR-N25 UBM-N28W23528E23 525. AND INFORMATION TNER DIUSTMENTS ;NDBES-T] NF NOTES LAND TOTAL USE IOCALFROTARE DEPTH/ LND GOND RF AC LC TO OA UNIT LAND UNP TOTAL PUTPRED IAND OVERRIDE OTECOD!ZONING TACE EPT SIZE MOD FAR OT PE PRICE UNITS WP AD35T UNIT PRICE VALUE VALUE MOTES 01201 1 �♦ 5.63 OTAL MARKET LAND DATA 5.68 49,56 OTAL PRESENT USE DATA http://66.226.39.229//ITSNet/AppraisalCard.aspx?parcel=L600000034 10/27/2014