246 Griffith RdJ
Apptrcant
Address.
Cay
State Zrp
p none =
OPERATION PERMIT """u"'v "'`"
`
Davie County Health Department GIL)P Fie dumber 122394-1
210 Hospital Street 67-000-00,063
P.O. Box 848 Cn�Jr,±y lD tlr;f'1~er
Ntocksville NC 27028 Fvaluated For. REPAIR
Phone: 336-753-6780 Fax; 336-753-1680 Toy;nship
C. Catherine Byrd Propc y 0:';nc C. Catherine Byrd
246 Griffith Road j Addre$s 246 Griffith Road
Advance i Cty Advance
NC 27006 I State Zip NC
Pro
erty Location & Site Information
Address Road ^ sulbdvisS on
246 Griffith Rd
Advance
__.. NC 27028
StrtJcture
SINGLE FAMILY
t:t Bedmo,-Is
3
r of People
• VIM ter 91J.oP!V
NA
.............................................
..........................................
'if' Issued by
22:1.1-Day:•al:. Arvjre;•.
'CA issued by
221.1 - Dayvial.. Andwo
Dos: o f Iov,
2 4 0
Sod Application Rate 0 3
td tnfication Field
Ho Drain I.1nes
1 otal .r rerWh Length
Trench SpaCinq
Trench Width
Agcttegate Depth
t:', nimun; Trench Deoth
6 0 tt
Phase
27006
Loi
Directions
Hwy 601 N. right on Hwy 801 Griffith road on left
•System Class;fication Descrrp'.,on
Saprolite systen.) ,._) Ves i -e l to
GiiA`.•'{i Y - hr"�Fi�iLLkL ;r�tl. d-tx;xr � '�'cti..
•t7lSirit)IJt;On Type � � ,��,
' Pre -Treatment
Y= '
Drain field
Sq rt
r^tlnches 0 C
0 Cl
6 x
I1'.C(1CS
'System Type INFILTRATOR QUICK •1 STANDARD
Inst ::er n,, rty carte
C:ertificatron =
Da.e 0 7/ 1 5/ 2 0 1 3
IfiL i5
Ltinirnurn Soil CU'v'er InchesApproval Status
t:,u ii.:utf: I 'ei,c.h va; it; nches, El Approved Cl Disapproved
I
faax{n Lim Sod Cover
Inches
CDP F le Number 122394 - 1 County ID Number: 137-U00-00-063
Septic Tank
f�iilSrlfit !_gat. Q ..
t.tanufact,,rer � •.;�
STB
Gallons
Datp 1 I
'Frier Brand
ST Narker [ Yes No .
Renfwced Tank ❑ Yes ❑ No
t Piece Tank ❑ Yes ❑ No
I.tall ufacc:,rer
PT
irich diameter
Installer
Pipe I.Pnglh
Gallons
Certification =
Pump 'T,.pe
Date
I
/
R ise r Sealed
❑
Yes
❑
No
Riser He:.ght
❑
Yes
❑
No (L'm G in
e:nto-ced -rank
❑
Yes
❑
No
. ? Piece Tank
U
Yes
U
No
Lona
Installer
Certrflcatian =.
'EHS 224•;-Dz:.1'l Atmore:.
Date 0 7/ 1 5/ 2 0 1 3
Approval Status 1t
❑ Approved ❑ Disapproved
- --... ---- _-.-------- -------------------
Pump Tank
Ir-staller-
Certification -
'EHS
Date I /
Approval Status
❑ Approved ❑ Disapproved
Supply Line
Pipe Site
irich diameter
Installer
Pipe I.Pnglh
feet
Certification =
Pump 'T,.pe
'EIIS
`Schedule
I;
Downs Volun e
P-essure Rated ❑ Yes
❑ No
Date
I 1
Approves: fart rigs ❑ Yes
❑ N0
Approval Status
Inches
❑
Approved ❑ Disapproved
Pump Requirement
Pump 'T,.pe
Installer.
I;
Downs Volun e
—
Gal Certification-
D revi D o vi n
Inches
'EHS
'Chain.
I /
Date
Valves Access,We
❑
Yes
❑
N o
Flo,.-; Adlusirr:ent Valve
❑
Yes
No
C':eck valve
❑
Yes
❑
No
Approval Status
PVC Unions
❑
Yes
❑
No
❑
Approved ❑ Disapproved
Vent Hale
U
Yes
U
No
-
Anti -siphon Hole
❑
Yes
❑
No
'('. P F1e ;lumt)er 122394-1
Electric Equipment
County ID Number:
67-000-00-063
NFLIA •tX sox or Fcuivalent❑Yes
❑
No
lr-stallei
r Box 12 Inches Above Grade
D
Yes
❑
NO
CertScahon =
Box Adj. To f Unip tank
J
Yes
❑
Nci
Coi du,t Seated
J
Yes
❑
No
'LITS
PLimpf.lar'uailyOperable
D
Yes
❑
No
'Activation f.'eznod
Date
I
I
Approval Status
Nairn Audible
i
❑Yes
❑
No
❑
Approved ❑
Disapproved
Alarm Visible
J
Yes
Ll
No
'Operaucn Permit completed by
AtI''horrzed SateAgen' _. Date of Issue 0 7/ 1 5/ 2 0 1 3
'-Ills System t;as been installed m comp) ante with applicable HC General Statutes Art:c-e 11. Chapter 130A Rules for
Se:;age Treatment and Disposal. 15A IJCAC 18A 1900 el Sea arid a`s condrions of the Improvement Perini t and
Coasiruc`ion ALithorzat;on This property Is served by a sewage septic system.
Rule 1961 requires that a Type septic system meet tl,.e follo:';ing cntet a
Minlniuni System Reviev: ByThe Local Health Department
I.lanagement Entily —_------ ---- -----_----__ _..-_----__.-__v__—
f,1 ui::r.Tum SNSteM Inspection Maintenance Frequency fay Certified Operator
Reporting Frequency By Ceriifed Operator
Rule 1961 r"eUM-es ttiat a t ype IV a -,d V septic Systems desKit'.ed tot a 1!orne bLIS iriess o:rner 11) List IT) aIMCI,]I) a valid contra c:
rh a Public WWI agernell' erit ty v; rh a certified operator or a private certifies; operator for the life of the septic systen•.
Rule 19+i1 reGul'es that T,1)e VI septic sy5te,,lis designet! fore home business ov:{7er must mair:tain a vako, con'ract v;4h a
publlC ma^agement entity a cert?fled operator for the life of the Septic system.
Rtlle 1961 (2) (P) rP,gLJI'PS a contract sh,91 be executed he%,;Pen 'f'e system ov.,tier tint! a InanagemPilt entity prior to the
issuance of an Operation Permit for a system reqsTired to be maintained by a public or private management er..try. ui less 're
s43tem o•:; ner and certified operator are the Sallie. -f tie contract shall require specific tergtnren)enis tot maintenance and
opera -ion responsibrli'ies of tt?e ov:ner and systerns opera'or prw sions that the contract shall be In effect for as long as the
sySteni Is Ji use. and other requirements for the continued proper performance, of t^e system t' shall also he a condition of
the Oaeration Penn it that subsequent ov.ners of tt�e sy5teriis execute such a contrac'
I -)Hand Drawing OImport Drawing
**Site Plan/Drawing attached.**
Act ivry Code S-11) 201.3 - Of' i sued NE'.'J Tyne 11 Ouick 4
T 'ai -in-:e iF-i
0 1 0 0
OPERATION PERMIT
+ Davie County Health Department CDP File Number: 122394 - 1
210 Hospital Street
County File Number:
P.O. Box 848 s� liiG G(;•(}�i
t;tocksvitle NC 27028 Date: 1 i
Inch
Scale:
nrawing Drawing Type: Operation Permit ��?N A k