1780 Farmington Rd (2)µ
OPERATION PERMIT
Davie County Health Department
.x..
t.t,3
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Wayne and Lynn Moyer
Address: 1780 Farmington Road
Cay: Mocksville
State!Zip: NC 27028
Phones::
Property Loca
i
AddresstRoad »: Subdivision:
1780 Farmington Road
Mocksville NC 27028
Structure: SINGLE FAMILY
of Bedrooms: 2
of People:
"Water Supply: N`A
'IP Issued by: 2244 - Daywilt. Andres:
"CA issued by: 2244 - Daywalt. Andrew
Design Flour: 2 4 0
Soil Application Rate: 0 2
NIrification Field
No. Drain Lines
Total Trench Length
Trench Spacing:
Trench Width:
Aggregate Depth:
3 n n ft.
'CDP File slumber 122068-1
D5•000.00-097.01
County ID Number:
Evaluated For: REPAIR
,,,Township-,
�roperty Owner Wayne and Lynn Moyer
Address: 1780 Farmington Road
City: Mocksville
State/Zip: NC 27028
Phone:::
ati
Phase: Lot:
Directions
140 East to Farmington Rd. Left, toward end
'System Classification/Description:
TYPE IIF.. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? (-)Yes ONo
'Distribution Type: GRAVITY - PARALLEL (eq. d•box) Pump Required?
QYes Drlo
'Pre -Treatment:
Drain field
Sq. It
()Inches O.C.
Feet O.C.
8 lncties
Feet
inches
'System Type: INFILTRATOR QUICK 4 STANDARD
Installer:
Certification:::
"EH S: 2244 - Daywalt. Andre:.
Date: 0 9/ 1 3/ 2 0 1 3
Minimum Trench Depth: Inches
I.tinimum Soil Cover-, Inches Approval Status
Maximum Trench Depth: Inches ElApproved ❑ Disapproved
I.taximum Soil Cover:
\ Inches
1
CDP File Number 122068 - 1
Manufacturer- existing
STB:
Gallons:
Date:
County ID Number: DS -000-00-097-01
Septic Tank
Lat.
Long:
Installer:
I / Certification 4:
'EHS:
'Filter Brand:
ST Marker.- ❑ Yes ❑ No Date:
nforced Tank: ❑ Yes ❑ NO Approval Status
1 Piece Tank: ❑ Yes ❑ No ❑ Approved ❑ Disapproved
Pump Tank
Manufacturer.
PT:
Gallons:
Date:
/
Riser Sealed ❑
Yes
❑
No
Riser Height: ❑
Yes
❑
No (Mm.6 in.)
Reinforced Tank: ❑
Yes
❑
No
`Piece Tank: ❑
Yes
❑
No
Pipe Size: inch diameter
Pipe Length: feet
`Schedule:
Pressure Rated ❑ Yes ❑ No
approved fittings ❑ Yes ❑ No
Installer:
Certification :::
"EHS:
Date:
Approval Status
❑ Approved ❑ Disapproved
Supply Line
Installer:
Certification »:
'ENS:
Date: / /
Approval Status
❑ Approved ❑ Disapproved
/ Pump Type: Installer:
Dosing Volume: - Gal Certification ::;
Draw Down: Inches 'EH S,
'Chan.
Date.
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check -valve ❑ Yes ❑ No Approval Status
PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved
Vent Hole ElYes 1:1N o
Anti -siphon Hole ❑ Yes ❑ No
CDP FileNumber 122068-1
N EIJA dX Box or Equivalent ❑ Yes
Box 12 inches Above Grade ❑ Yes
Box Adj. To Pump Tank ❑ Yes
Conduit Sealed ❑ Yes
Pump Manually Operable ❑ Yes
'Activation Method:
Electric EauiDment
❑ No
❑ No
❑ No
❑ No
❑ No
Alarm Audible ❑ Yes ❑ No
Alarm Visible ❑ Yes ❑ No
2242 - Daywal2. Andrew
County ID Number: D5-000.00-097-01
Installer:
Certification:
'EHS
Date:
Approval Status
❑ Approved ❑ Disapproved
'Operation Permit completed by,
Authorized State Agent: C1Jt.� 9r Date of Issue: 0 9/ 1 3/ 2 0 1 3
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 all conditions of the Improvement Pennit and
Construction Authorization, This property is served by a TYPE 11 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 11aintenance Frequency ByCertihed Operator:
NIA
Reporting Frequency By Certified Operator: N'A
Rule .1961 requires that a Type IV and V septic systems designed fora home:business owner must maintain a valid contract
with a public management entityw4h a certified operatoror a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora 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 priorto the
issuance of an Operation Permit for a system required to be maintained by a public or private management entrly, 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 Pemnit that subsequent owners of the systems execute such a contract.
01 -land Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Activity Code: S-19 204 - OP issued NEW Type 11 Quick 4
Total Time.(HH:1.11')
0 1 Hours 3 0 Hinuies
OPERATION PERMIT 122068-1
Davie County Health Department CDP File Number:
210 Hospital Street
County File Number: D5-000-00.097.01
P.O. Box 848
Mocksville NC 27028 Date:
OEnch
D'MwinoDrawing Type: Operation Permit Scale: OBlock
t•1 rn
A
$01 1I
r�
CONSTRUCTION For Office use Only
AUTHORIZATION `CDP File Number 122068-1
• ,"""�' Davie County Health Department County ID dumber: D5-000.00-097.01
V N
210 Hospital Street Evaluated For: REPAIR
P.O. Box 848 To:vnship:
.:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 6/ 2 6/ 2 0 1 8
FAdd
ant: Wayne and Lynn Moyer Property Owner: Wayne and Lynn Moyer
ss: 1780 Farmington Road Address: 1780 Farmington Road
Mocksville City:Mocksville
ip: NC 27028 State/Zip: NC 27028
Phone -:
AddresslRoad Subdivision:
1780 Farmington Road
Mocksville NC 27028
Structure: SINGLE FAMILY
n of Bedrooms: 2
# of People:
'Water Supply: NIA
Phone #:
Phase: Lot:
Directions
140 East to Farmington Rd. Left, toward end
ification
4 I_ I -D Page 1 of 3
Minimum Trench Depth:
Inches
Site Classification: PS
Minimum Soil Cover.
Saprolite System? 'C,'Yes No
O
Inches
Design Flow:
Maximum Trench Depth:
Inches
Soil Application Rate:
tAaximum Soil Cover:
Inches
'System ClassificationiDescription:
'Distribution Type: GRAVITY - PARALLEL (eq, d•box)
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
'Proposed System: CONVENTIONAL
1 -Piece: Oyes
ONo
Pump Required: OYes ONo
OMay Be Required
Nitrification Field
Sq. ft. Pump Tank:
talions
No. Drain Lines
1 -Piece: OYes
ONo
Total Trench Length:
GPf.t—vs--
ft. TDH
ft
Trench Spacing: _
_8
Inches O.C.
Feet O.C. Dosing Volume:
Gallons
Trench Width:Inches
_
Feet Grease Trap:
Gallons
Aggregate Depth:
inches
Pre -Treatment: ONSF OTS -1 OTS -II
Septic Tank Installer Grade Level Required: 01 011 OIII
OIV
4 I_ I -D Page 1 of 3
CDP File Number 122068-1
County ID Number: D5-000.00-097-01
❑ Open Pump System Sheet
air system Kequirco:vTe5yivv 1zonty, r7UL [I db myallaDre opace
Trench Spacing:Q Inches 0.
*Site Classification: PS — o Feet O.C.
Trench Width:8Feet Inches
Design Flow: 2 4 0 _
Soil Application Rate: 0 - 2 Aggregate Depth: inches
Minimum Trench Depth: 3 6
*System Classification/Description: Inches
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover.
Inches
'Proposed System: CONVENTIONAL Maximum Trench Depth:4 8 Inches
Maximum Soil Cover.
Nitrification Field Inches
Sq. ft.
No. Drain Lines 'Distribution Type: GRAVITY- PARALLEL (eq. d -box)
Total Trench Length: 2 0 0 ft Pump Required: Oyes ONo OMay Be Required
'I-, Pre -Treatment: ONSF OTS -1 OTS -II
'Site Modifications
No grading or construction activity is allowed in areas designated for system and repair %vithout approval of Health Department.
'Permit Conditions
The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
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 maybe issued at the same time the Improvement Permit issued (NCGS 130A-336(b)j 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 (.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, maintenance6 monitoring, reporting and repair
(1938(b)).
Applicant'Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature- Date: / /
'Issued By.- 224.1- Daywalt, Andrew Date of issue: 0 6 / 2 6 / 2 0 1 3
Authorized State Agent: CA ,ll Malfunction Log OYes
OHand Drawing Olmport Drawing Total Time: 11-11-111 LI)
**Site Plan/Drawing attached.**
Page 2 of 3 1 Hours 0 0 tt mutes
S-10 - CNS issued - repair
CONSTRUCTION AUTHORIZATION
• Davie County Health Department CDP File Number: 122068 -1
210 Hospital Street D5-000-00-097-01
P.O. Box 848 County File Number:
Mocksville NC 27028 Date: 0 6/ 2 6/ 2 0 1 3
Olnch
Drawing Drawing Type: Construction Authorization Scale:. OBlock = ft.
ON/A
App; sisal Card
DAVIE COUNTY, NC
Page 1 of 1
6/25/2013 8:47:22 AM
MOYER WAYNE MOYER LYNN Return/Appeal Notes: DS -000-00-097-01
1780 FARMINGTON RD UNIQ ID 3820
2234300 D112 -P15 1D NO: 5842761402
COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1
eval Year: 2013 Tax Year: 2013 .86 AC FARMINGTON RD 0.820 AC SRC- Owner
Appraised by 02 on 09/06/2007 03004 FARMINGTON TW -03 C- EX- AT- LAST ACTION 20120223
CONSTRUCTION DETAIL MARKET VALUE
DEPRECIATION
CORRELATION OF VALUE
oundation - 3
Standard 0.2800
ontinuous Footin 5.0
MO
Eff.
AreaUA
BASE
RATE RCN
EYB AYB
CREDENCE TO MARKET
ub Floor System - 4 US
01
12,1111111
77.70
1668241985190
% GOOD 1 72.0
DEPR. BUILDING VALUE- CARD 120,11C
PI ood 8.0 01
xterior Walls - 10 TYPE: Single Family Residential Single Family Residential
DEPR. OB/XF VALUE - CARD 88
Iuminum/Vln I Siding 29.00
MARKET LAND VALUE - CARD 20,95
oofing Structure - 03 STORIES: 3 - 2.0 Stories
TOTAL MARKET VALUE - CARD 141,94
able 8.0
coring Cover - 03
%sphalt or Composition Shingle 3.0
TOTAL APPRAISED VALUE - CARD 141,94
nterior Wall Construction - 5
TOTAL APPRAISED VALUE - PARCEL 141,94
)rywall/Sheetrock 26.0
nterior Wall Construction - 6
TOTAL PRESENT USE VALUE - PARCEL
ustom Interior 0.0c
rOTAL VALUE DEFERRED - PARCEL
nterior Floor Cover - 12
rOTAL TAXABLE VALUE - PARCEL 141,94
ardwood 10.0
PRIOR
nterior Floor Cover - 14
BUILDING VALUE 128,33
-arpet 0.0c
eating Fuel - 03
BXF VALUE
as 1.0
LAND VALUE 19,72
eating Type - 04
PRESENT USE VALUE
orced Air - Ducted 4.00
DEFERRED VALUE
it Conditioning Type - 03
TOTAL VALUE 148,05C
entral 4.0
Bedrooms/Bathrooms/Half-Bathrooms
/2/0 10.00
+---22---+
Bedrooms + - 12-+ I +8-+
PERMIT
BAS - 0 FUS - 2 LL - 0 I W D D I I I F U S
CODE I DATE I NOTE I NUMBER AMOUNT
Bathrooms I I I I +---24----+
BAS -IFUS -ILL-0 I I I I I
ROUT: WTRSHD:
fflce 2 2 3 2 I
SALES DATA
8 8 1 62
OTAL POINT VALUE 108.00 1 1 1 1 I
INS ID LESTE
BUILDING ADJUSTMENTS I I I I I
RECORD DATE DEED
uality 3 AVG 1.000 +4+8-+ ++-12-+ +-----32-----+BOOK
PAGEM R TYPE
PRICE
0185
908 3 199 WD
Q
I 9800
I B A S I F C P I
lze 3 Size 0.940
I I I
0175
129 6 199 WD
i 9300
ha a/Desi 5 FACTOR 5 1.100 2 1 1
OTAL ADJUSTMENT FACTOR 1.03 0 8 8
OTAL QUALITY INDEX 111 I I I
I II
+6+---20---+6+-12-+
HEATED AREA 2,010
7FOP 7
NOTES
+---20---+
FROMMRS. O.R. ALLEN
FROM MILLER, EDWARD E
FROM JOSEPH H LOFLIN JR
SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR
TYPE GS AREA % RPL CS ODE DESCRIPTIO LTH H NIT PRICE COND BLDGi� L B AYB EYB RATE V GOND VALUE
BAS 1 322 10 10271 1 TORAGE 1 1 12 10.0 _ _ 200 00 5 7A 87
CP 21 02 419 OTAL OB/XF VALUE 87
FOP 14 03 380
FUS 6881 09 4809
DD 33N 021 520
4 - 2 Story Single/1 Story
IREPLACE 2 80
Double
UBAREA
OTALS 2,70 166,82
BUILDING DIMENSIONS BAS=W2N31W22S3 WDD=W12S28E12N28$S28W8S20E6 FOP=S7E20N7W20$E26NI FCP=E12N18W12S18$ N19$ PTR=E25 FUS=E32N2OW24N6W8S26$W25
ND INFORMATION
IGHEST
THER ADJUSTMENTS
LAND TOTAL
NO BEST
USE
LOCAL FRO N
DEPTH /
LND
GOND�11RF
NO NOTES
ROA
UNIT LAND UNT
TOTAL
ADJUSTED LAND LAND
SE
CODE
20NING TAGE DEPTH
SIZE
MOD
FACT
AC LC TO OT
TYPEPRICE
UNITS TYP
ADJST
UNIT PRICE VALUE NOTES
URAL AC
0120
103 0
2.6080
4
1.1500
05 +10 +00 +00 +00
PW
8,500.00 0.822 AC
2.99A
25,491.50 2095
TOTAL MARKET LAND DATA 0.822 20,950
TOTAL PRESENT USE DATA
bpi 11ZoozX
O
O
r�
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