2021 Hwy 158 (2) OPERATION PERMIT f or ice se ny
Davie County Health Department 'CDP File Plumber 121744 - 1
? ��tl� 210 Hospital Street
P.O. Box 848 County ID Number
Mocksville NC 27028 Evaluated For. NEW
Phone:336-753-6780 Fax:336-753-1680 Tov.nship- ,
Applicant, Cipnouo M. Cmquito ,�"Pro, 4y O:vner. Cipnouo M. Cmquito
Address. 2021 Hwy 158 Address. 2021 Hwy 158
City Mocksville City Mocksville
Stete'Zip: NC 27028 State Zip NC 27028
Pl;one=: (336) 751-1152 :' �� phone= (336)751-1152 ?
Property Location & Site Information
Address Road = Subduis*n. Phase. Lot
x'2021`H�y� $
Mocksville NC 27028 Directions
Structure OTHER Hwy 158 toward Advance
of Bediooms
of People
''•'Vater Supple PUBLIC
..........................................................................................................................................................................................................................................................................
='IP Issued by 22.4.4-Dayc:a►t.Andrew
`Systein Classification: Description
t TYPE II A.CON)!SYSTEM iSINGLE-FAML Y OR•183 GPD OR LESSI
'CA issued by 22-13-Daywalt.Andre-.4;
Saprolite Systems r."y?Yes ('),No
Design Flov; 1 5 0V Y-SERIAL S• Pjmr Require?
Ye S
`Dsinbut:on Type c�Rr.;It,
Soil Application Rate 0 3 `Pre-Treatment N A
Drain field
Sq ft. INFILTRATOR CUICK:STANDARD
f+, tddnfication Field 'System Type �
No Drain l_mes Instai'er, hnan mcdaniel
Total Trench, Length 1 2 8 It Cemfication
Trench Spacing — r4c.Inches 0 C
;Feet U.C. 'F-HS 2244-Dayr:alt.Andra:
Trench V1'idth (-flitches
i�!Feet Date 0 7 / 1 7 / 2 0 1 3
Acyregate Death r;ches
Minimum Trench Death
Inches
Minimum Soil Cover Inches Approval Status
I.Saxirnum l reach Depth. 3 6 InchP, ❑ Approved❑ Disapproved
Maximum Soil. Cover Inches
— --- —
CDP File I(umber 121744 - 1 County 1D Number:
Septic Tank
sraotaf Lat.
1.1 a n of a ctu re r
Long-
STB: 7,.4 0 .
Gallons 1000 Installer
Date 0 2 / 1 8 / 2 0 1 3 Certification
"EHS 22•::1-Day:;L Andre:
'Filter Brand
ST taa*ker [--j .Yes n No
Date. 0 7 / 1 7 / 2 0 1. 3
rReinfo-ced Tank ❑ Yes ❑ No Approval Status
Prece Tank ❑ Yes ❑ No ❑ Approved ❑ Disapproved �!
Pump Tank
;' Manufacturer Installer-
PT Certification
Gallons' 'EHS
Date / Date /
RserSealed ❑ Yes ❑ No
Riser Height ❑ Yes ❑ No (1,11 in G in )
Approval Status
�cinfo,ced Tank ❑ Yes ❑ No ❑ Approved❑ Disapproved
`• i Piece Tank U Yes 0 No
Supply Line
rr
f�. Pipe Size arch diameter Installer
P;pe 1,eng1h feet Certification =
"EHS
'Schedule
Pressure Rated ❑ Yes ❑ No Date
Approved fritings ❑ Yes ❑ No Approval Status
❑ Approved❑ Disapproved
Pump Requirement
Purnp Type Installer.
Dosing Volume — Val Certification=
Drew Dorn Inches 'EHS,
'Ghali. /
Date
Valves Accessible ❑ Yes ❑ No
Flov., Adjustment Vplve ❑ Yes ❑ No
Check valve ❑ Yes ❑ No Approval Status
Pvc unions ❑ Yes ❑ No D Approved❑ Disapproved
Vent Hole ❑ Yes 0 No
t
Anti-siphon Hole ❑ Yes ❑ No
4� ...............................................:.....:.............................:.............................................. :.....:...........:.....:.....:............:... ... ...._..............
CDP Fite Number 121744 - 1 County ID Number:
Electric Equipment
` flFI•IA-IX Box or Fquwalent ❑ Yes ❑ No
Installer
�
Box 12 inches Above Grade ❑ Yes ❑ No
Certification-'
Box Adj. To Pump Tank J Yes ❑ No
Condut Sealed J Yes ❑ No 'Elis
Pimp1.1anualIvOperable ❑ Yes ❑ No I
'Activation Method, Date.
Alarm Audible ❑ Yes ❑ No Approval Status
El Approved❑ Disapproved
Alarm Visible J Yes L] No
221.1-Day twat;.Andres:
'Operation Permit completed by
Authorized State Agent Date of Issue 0 7 / 1 7 2 0 1 3 ,
This system Inas been installed in compliance with applicable I1C General Statutes Art.cte 11. Chapter 130A Rules for
Sev;age Treatment and Disposal. 15A IJCAC 18A 1900 e; Seq and ail conditions of the Improvement Permit and
Construction Authorzatmn This property is served by a TYPE IIA Setiti'age Septic System.
Rule 1961 requires that a Type TYPE 11A _____ septic system meet the folio% ing criteria
f.1111mium Systerl Revie; By The Local Health Department NA
Mai agement Entity _UNNER_____
f.tulirnum SYstern Inspection Maintenance Frequency By Certified Operator
NA
............. ............._..:...............................:.....................................................................................................-.......... ................................. .............................
Reporting Frequency By Certified Operator N _ ______
Rule,1961 requires that a Type IV and V septic systems designed for a borne business o::ner must maintain a valid contract
tvrh a public nlanagenlent entltyvirh a certified operator or a private certified operator for the life of the septic sy'stern
Rule 1961 requires that Type VI septic systeins designed for a home business owner must maintain a valid contract with a
public management entity oath a certified operator for the life of the septic system.
Rule 1961 (2)(e)requires a contract shall be executed bet:veen the system oti ner and a management entrly prior to the
sssi..ance of an Operation Permit for a system required to be maintained bya public or private management entry. unless the
system owner and cer,itied operator are the sane. T tie contract shall require specific requirements for maintenance and
operation responsibilities of the ov;ner and systems operator provisions that the contract shall be In effect for as longus the
system is in use, and other requirements for the continued proper performance of the system h shall also be a condition of
the Operation Perritt that subsequent owners of the systems execute such a contract
-)Hand Drawing CAmport Drawing
**Site Plan/Drawing attached.**
Tctat'ime rr t!I.-;i
Acts,/ry Code S-1920-1-OP issued NE.";Type 11 Quick.4 0 1 N ws 0 0 •' e
OPERATION PERMIT
Davie County Health Department CDP File Number: 121744 - 1
210 Hospital Street
P.O.Box sag County File Number:
ttlocksville NC 27028 Date: t 1
_ tInch
Scale: . (:s Block = `t.
Dra«ina Drawing Type: Operation Permit N-A
fo
F � � '
Parcel#: H50000002404 Page 1 of 1
oA�r�
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Parcel#:H50000002404 Account#:8301247
Owner Information Tax Codes
ENDEZ CHIQUITO ADVLTAX-COUNTY T
07 AVON STREET FIREADVLTAX-FIRE TAX
OCKSVILLE NC 27028
Property Information Township
nd(Units/Type): 19.175 AC MOCKSVILLE
ddress: 2021 US HWY 158
Deed Information Local Zoning
Pate: 04/2013 Book: 00923 Page: 0817
Plat Book: Page:
Le al Description PIN
0.175 AC HWY 158 19.175 AC 5749174108
Property Values
r
in: 5 96132 86et: 13882sed• 138 82
eferred•
Sales Information
No. Book Page Month Year Instrument Quai/UnQual Improved Price
00184 0900 01 1996 WD Unqualified Vacant 0
00713 0248 05 2007 WD Unqualified Improved 0
00922 0494 04 2013 CD Unqualified Vacant 0
00923 0817 04 2013 CD Unqualified Vacant 0
00154 0061 05 1990 WD Qualified Vacant 60,000
00161 0468 11 1991 WD Qualified Vacant 50,000
00184 0902 01 1996 WD Qualified Vacant 55,000
00897 0834 07 2012 WD Qualified Vacant 130,000
View Property Record for this Parcel View Man for this Parcel View Tax Bill Information
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All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be
consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County,
its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1466286 6/14/2016