5060 Hwy 601Na
OPERATION PERMIT
�s fswt.
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Eric Wilkins
Address: 5060 US Hwy 601 N
Cly: Mocksville
State2ip: NC 27028
Phone #: (336) 215-7673
Address/Road #: Subdivision:
5060 US Hwy 601 North
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms. 4
# of People:
*Water Supply: N/A
*IP Issued by. 2140 -Nations, Robed
*CA issued by: 2140. Nations, Robert
Design Flow: 3 6 0
Soil Application Rate: 0 a 7 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
perty Owner. Eric Wilkins
Address: 5060 US Hwy 601 N
City: Mocksville
State2ip: NC 27028
111Phone #: (336) 215-7673 +
Phase: Lot:
Directions
Hwy' 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with
large oak trees
*System Class ification/Description:
TYPE 1118. SYSTEM W/SINGLE EFFLUENT PUMP
Saprolite System? OYes (No
*Distribution Type: PUMP TO GRAVITY Pump Required?
QYes pONo
*Pre Treatment:
Drain field
1 3 0 9 Sq. ft.
3
1 3 0 9 8•
Inches O.C.
9 Feet O.C.
3 @Inches
Feet
inches
*System Type: INFILTRATOR OUICK 4 STANDARD
Installer: Jamie Bames
Certification #: 1018
*EH S: 2140 -Nations. Robert
Date: 0 3/ 0 1/ 2 0 1 6
Minimum Trench Depth:
3
6_
Inches
Minimum Soil Cover.
4
Inches
Approver Status
CDP File Number
198364-1
County ID Number 133.000.00.034-06
Manufacturer: shwf
installer iamie Bames
Septic Tank
Manufacturer.
Certification #: 1018
Gallons: 1000
Lat. -
THS: 2140 - Nations, Robert
Date: 1 1 / 1
4
Long:
STB:
5 Date: 0 3 / 0 1/ 2 0 1 6
RiserSealed Q Yes
❑
No
Gallons:
RiserHeght: D Yes
❑
No
(Min.6 in.)
s, APprovai St'
Installer.
Date:
No
/
/
Certification #:
❑
No
*EH S:
*Fitter Brand:
Supply Line
Pipe Size: a inch
diameter
ST Marker.
❑
Yes
❑
No
Date:
Reinforced Tank:
El
Yes
❑
No
;Approval Status
Pressure Rated D Yes
❑
No
Date: 0 3/ 0 1/ 2 0 1 6
,❑ Approved --TN,,Dtsapproved
C3
1 Piece Tank:
❑
Yes
❑
NO
Pump Tank
Manufacturer: shwf
installer iamie Bames
PT: 90
Certification #: 1018
Gallons: 1000
THS: 2140 - Nations, Robert
Date: 1 1 / 1
4
/_ a
0 1
5 Date: 0 3 / 0 1/ 2 0 1 6
RiserSealed Q Yes
❑
No
RiserHeght: D Yes
❑
No
(Min.6 in.)
s, APprovai St'
Reinforced Tank. D Yes
❑
No
ve
® Approd ❑ Dtsapprovecl
1 Piece Tank: D Yes
❑
No
Supply Line
Pipe Size: a inch
diameter
installer. Jamie Bames
Pipe Length: 5 0
feet
Certification : 1018
"ENS: 2140 - Nations. Robert
"Schedule: 40
Pressure Rated D Yes
❑
No
Date: 0 3/ 0 1/ 2 0 1 6
Approved fAtings D Yes
C3
No
gpproval S#etas
j ,,❑'Approved❑==Disapproved,
Pump Type: Zoeler
Pump
Requirement
Installer: Jamie Barnes
Dosing Volume:
-
Gal Certification #: 1018
Draw Down:
Inches
"EH S: 2140 - Nations. Robert
"Chain: ROPE
Date: 0 3/ 0 1/ 2 0 1 6
Valves Accessible D Yes
❑
No
Flow Adjustment Valve Q Yes
❑
No
Check -valve D Yes
❑
No
����- Approval eta#us%
PVC unions p Yes
❑
No
®Approvetl ❑v Dtsappro�ed
Vent Hole
❑Yes
❑
N o
Anti -siphon Hole p Yes
0
No
CDP Fite Number 198364 - 1
Electric EaulDment
County ID Number: 83-000-MO34-06
NEMA 4X Box or Equivalent
M
Yes
❑
No
Installer. Jamie Bames
Box 12 inches Above Grade
O
Yes
❑
No
1018
Certification #:
Box Adj.To Pump Tank
[E
Yes
❑
No
Conduit Sealed
[E
Yes
❑
No
"ENS: 2140 • Nations, Rout
Pump Manually Operable
p
Yes
❑
No
2 1 6
*Activation Method:
Date: 0 3/ 0 1/ 0
�►PPraval status
Alarm Audible
®Yes
El
No
CD Approved ❑ Disapproved
Alarm Visible
®
Yes
❑
No-=
2140 • Nations, Robert
*Operation Permit completed by:
Authorized State A en . Date of Issue: 0 3/ 0 1/ 2 0 1 6
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 all conditions of the Improvement Permit and
Construction Authorization. This property is served bye riPE nl B. sewage septic system.
Rule .1961 requires that a Type TYPE III B. septic system meet the following criteria:
Minimum System Review By The Local Health Department: SYR$.
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator.
NIA
Reporting Frequency By Certified Operator. NIA
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 entitywith a certified operator or a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed for a hometbusiness 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 envy prior to the
issuance of an Operation Permit fora system required to be maintained by public or private management envy, 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.
(91 -land Drawing Olmport Drawing
**Site Plan/Drawing attached.**'
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Drawing Type: Operation Permit
CDP File Number: 198364-1
County File Number: B3 -Q00-00-034-06
Date:
Olnch
Scale: OBlock — A.
ON/A
■n
CSC
C'
■
■
o.
i Address/Road #:
5060 US Hwy 601 North
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
*Water Supply: N/A
Subdivision:
Phase: Lot:
Directions
Hwy 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with large
oak trees
Classification:
Provisionally Suitable
Minimum Trench Depth:
CONSTRUCTION
Inches
\/Site
For Office Use Only
O Yes (1 No
AUTHORIZATION
*CDP File Number 198364-1
1 a
Davie County Health Department
Design Flow:
County ID Number: B3-000-00-034-06
100
210 Hospital Street
Maximum Trench Depth:
luated For: EXPANSION
--.
P.O. Box 848
0 a 7
Gwnship:
Mocksville NC 27028
PERMIT VALID UNTIL:
Inches
Phone: 336-753-6780 Fax: 336-753-1680
0 1/ a a a 0 a 1
Applicant:
Eric Wilkins
Property Owner: Eric Wilkins
Address:
5060 US Hwy 601 N
Address:
5060 US Hwy 601 N
City:
Mocksville
City:
Mocksville
State/Zip:
NC 27028
State/Zip:
NC 27028
Phone #:
(336) 215-7673
Phone #:
(336) 215-7673 J
i Address/Road #:
5060 US Hwy 601 North
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
*Water Supply: N/A
Subdivision:
Phase: Lot:
Directions
Hwy 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with large
oak trees
Classification:
Provisionally Suitable
Minimum Trench Depth:
a 4
Inches
\/Site
Saprolite System?
O Yes (1 No
Minimum Soil Cover:
1 a
Inches
Design Flow:
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:
PUMP TO GRAVITY
TYPE III B. SYSTEM
W/SINGLE EFFLUENT PUMP
Septic Tank:
Gallons
*Proposed System: 25016 REDUCTION
1 -Piece:
O Yes
O No
Pump Required: ® Yes
O No
O May Be Required
Nitrification Field
1 3
0
9
Sq. ft. Pump Tank:
1
0 0 0 Gallons
No. Drain Lines
3
1 -Piece:
OYes
®No
Total Trench Length:
3 a 7
GPM -vs-
ft. TDH
ft
Trench Spacing:Q
-
g
O
Inches O.C.
Feet O.C. Dosing Volume:
_
Gallons
Trench Width:
3
Olnches
®
Feet
-
Grease Trap:
Gallons
Aggregate Depth:
inches Pre -Treatment: O NSF OTS -1 OTS -11 /
Septic Tank Installer Grade Level Required: 01011 O III O IV
Page 1 of 3
CDP File Number 198364 - 1 County ID Number: 63-000-00-034-06
uirea:lJ r es V IVU %& IVU, UUt ll"ds /1VdlldU!U J
*Site Classification: Provisionally suitable
Design Flow: 3 6 0
Soil Application Rate: 0 a 7 5
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 25% REDUCTION
Nitrification Field 1 3 0 9 Sq. ft.
No. Drain Lines 3
Total Trench Length: 3 a 7 ft
❑ Open Pump System Sheet
Trench Spacing:
_ 9
Inches O.
Feet O.C.
Trench Width:
_ 3O
�1
Inches
Feet
Aggregate Depth:
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover:
1
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover:
a
4
Inches
*Distribution Type: PUMP TO GRAVITY
Pump Required: (&Yes 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. a m29
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. Characters
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? O Yes O No
Applicant/Legal Reps. Signature- Date:
*Issued By: 2140 - Nations, Robert 14Date of Issue: 0 1 a 5 a 0 1 6
Authorized State Malfunction Log OYeSk�
0 Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
• Drawing Drawing Type: Construction Authorization
CDP File Number: 198364 - 1
County File Number: B3-000-00-034-06
Date: 01 Va5/.2016
Olnch
Scale: O Block
O N/A
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
CDP File Number: 198364 - 1
P.O. Box 848
Cut File u
y-1qmber: B3 -000-00-034-0s
Mocksville NC 27028 Oca- 0 �y— ` `�' j 4 p G �- , (ao Dllate:.0 1. / .25 /.a.0.1.6.
Click below to import an image from an ekternal location:
`ZUF /.P/,-
G,it u�G -
Drawing Type: Construction uization
J� q Li LL)
Page 3 of 3
P1 P2 '.
CONSTRUCTION
AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Address/Road M Subdivision: Phase: Lot:
5060 US Hwy 601 North
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with large
# of Bedrooms: oak trees
# of People:
*Water Supply: WA
rooc�l +� Fou)
Classification: Provisionally suitable
Saprolite System? OYes ®No
Design Flow: 3 6 0
Soil Application Rate: 0 2 7 S
'System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
'Proposed System: 25% REDUCTION
Minimum Trench Depth: .2 4
Inches
Minimum Soil Cover 1 2
Inches
Maximum Trench Depth: 3 6 Inches
Maximum Soil Cover: 2 4
Inches
"Distribution Type: PUMP TO GRAVITY
Septic Tank Gallons
1 -Piece QYes 0 N o
Pump Required: ®Yes QNo OMay Be Required
Nkrification Field
Phone: 336.753-6780 Fax: 336.753-1680
0 1/ 2 2/ 2 0.2 1
Applicant:
Enc Wilkins
Property Owner.
Eric Wilkins
Address:
5060 US Hwy 601 N
Address:
5060 US Hwy 601 N
City:
Mocksville
City:
Mocksville
State/Zip:
NC
27028 StatefLip:
NC 27028
Phone #:
(336) 215-7673
Phone #:
(336) 215-7673
Grease Trap: Gallons
Property
Location & Site Information
Address/Road M Subdivision: Phase: Lot:
5060 US Hwy 601 North
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with large
# of Bedrooms: oak trees
# of People:
*Water Supply: WA
rooc�l +� Fou)
Classification: Provisionally suitable
Saprolite System? OYes ®No
Design Flow: 3 6 0
Soil Application Rate: 0 2 7 S
'System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
'Proposed System: 25% REDUCTION
Minimum Trench Depth: .2 4
Inches
Minimum Soil Cover 1 2
Inches
Maximum Trench Depth: 3 6 Inches
Maximum Soil Cover: 2 4
Inches
"Distribution Type: PUMP TO GRAVITY
Septic Tank Gallons
1 -Piece QYes 0 N o
Pump Required: ®Yes QNo OMay Be Required
Nkrification Field
1 3 0
9 Sq. ft.
PumpTank: 1 0 0 0 Gallons
No. Drain Lines
3
1 -Piece: Oyes *No.
Total Trench length:
3 a 7 ft.
GPM vs— ft. TDH
Trench Spacing:
_ 9
0Inches O.C. Dosing
Feet O.C.
Volume: _ Gallons
Trench Width:Inches
3
.
Feet
Grease Trap: Gallons
Aggregate Depth:
inches Pro -Treatment: ONSF OTS -1 OTS -11
Septic Tank Installer Grade Level Required: 01 Oil 01111 OIV
Dann 4 nf'3
CDP File Number 198364 - 1
Repair System Required:OYes
83-006-00-034-06
County ID Number.
❑ Open Pump System Sheet
ONO @No, but has Available Space
System
rDesign
Trench Spacing:
0 Inches
9
ification: Provisionally Suitable
net C.
Trench Width:
Inches
w:3 6 0
— - Feet
Aggregate Depth:
Soil Application Rate: 0 - a 7 5
inches
.�
Minimum Trench Depth:
a 4
"System Classification/Description:
Inches
TYPE Ill B. SYSTEM W/SINGLE EFFLUENT PUMP
Minimum Soil Cover.
1 a
Inches°
Maximum Trench Depth:
3 6
"Proposed System: 25% REDUCTION
Inches
Maximum Soil Covera
� 4
Nitrification Field 1 3 0 Sq. ft.
Inches
No. Drain Lines 3
"Distribution Type:
PUMP TO GRAVITY
Total Trench Length; 3 a
Pump Required: ayes
ONo OMay Be Required
Pre -Treatment: ONSF
OTS -1 OTS -II
'Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without 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 may be 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 orConstnrction 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. maintenance; monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature: Date: ,
2140 - Nations, Robert
„ 0 1% x 5 / a$ 1 6
Issued By: Date of Issue: -
Authorized State A Malfunction Log OYeS c
®Hand Drawing 0lmport Drawing
**Site Plan/Drawing attached.**
Page 2 of
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Drawing.Type: Construction Authorization
CDP File Number. 198364 -1
County File Number: B3'000-00-034-06
Date: 01/25/.1015
Q Inch
Scale: QBlock = A.
QN/A
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street CDP File Number: 198364 " 1
P O B 848
.. ox County File Number: B3,000-00-034-01Mocksville NC 27028
Date: .0.1 / 2 5/2016
Click below to Import an Image from an external location: Drawing Type: Construction Authorization .
Applicant:
Address:
City:
State/Zip:
Phone #:
I
CONSTRUCTION
AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Eric Wilkins
5060 US Hwy 601 N
Mocksville
NC 27028
(336) 215-7673
Address/Road #:
5060 US Hwy 601 North
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: .4
# of People:
*Water Supply: N/A
Subdivision:
For Office Use Only
*CDP File Number 198364 - 1
County ID Number: B3-000-00-034-06
Evaluated For: EXPANSION
Township:
PERMIT VALID UNTIL:
1 2/ 0 7/ 2 0 2 0
Property Owner: Eric Wilkins
Address: 5060 US Hwy 601 N
City: Mocksville
State/Zip: NC 27028
Phone M (336) 215-7673
Phase: Lot:
Directions
Hwy 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with large
oak trees
Page 1 of 3
Minimum Trench Depth:
� 4
Site Classification:
Provisionally suitable
Inches
Saprolite System?
O Yes (9 No
Minimum Soil Cover:
1 )
Inches
Design Flow:
4 8 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:
PUMP TO GRAVITY
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
Septic Tank:
Gallons
*Proposed System: 25% REDUCTION
.1 -Piece:
O Yes
O No
Pump Required: ® Yes
O No
O May Be Required
Nitrification Field
1 7
4
5
Sq. ft. Pump Tank:
1
0 0 0 Gallons
No. Drain Lines
4
1 -Piece:
OYes
®No
Total Trench Length:
4 3 6
GPM --vs—
ft. TDH
ft.
Trench Spacing:
—
9
® OInches
O.C.
Feet O.C. Dosing Volume:
—
Gallons
Trench Width:
3
R
Inches
Feet
—
Grease Trap:
Gallons
Aggregate Depth:
inches
Pre -Treatment: O NSF OTS -1 OTS -11
Septic Tank
Installer Grade Level Required: 01
Oil 0111
O IV
Page 1 of 3
CDP File Number 198364 - 1 County ID Number: B3-000-00-034-06
r Svstem Required: ®Yes ONO ONO, but has Available
*Site Classification: Provisionally Suitable
Design Flow: 4 8 0
Soil Application Rate: 0 a 7 5
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
1 3 4 5 Sq. ft.
4
436
Minimum Trench Depth:
ft.
❑ Open Pump System Sheet
Trench Spacing: 90 Inches O.
0 Feet O.C.
Trench Width: — 3 R Inches
Feet
Aggregate Depth:
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover:
1
a
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover:
a
4
Inches
*Distribution Type: PUMP TO GRAVITY
Pump Required: ®Yes O No O May Be Required
Pre -Treatment: O NSF OTS -I OTS -11
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Remem1ms
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. eaerRmg
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? O Yes ONO
Applicant/Legal Reps. Signature- Date: /
*Issued By: 2140 Nations, Robert Date of Issue: 1 0 7 / a 0 1 5
Authorized State Age Malfunction Log OYes
t.aa
® Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
Drawing Drawing
15M AA -C-1 I
L
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Construction Authorization
D
Page 3 of 3
r
I
CDP File Number: 198364-1
County File Number: B3-000-00-034-06
Date: 12/07 .1015
0 Inch
Scale: 0 Block
0 N/A
k
I
A,
P1 P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC
Click below to import an image from an external location
27028
CDP File Number:
County File Number:
198364-1
B3-000-00-034-06
Date:.l.a./ 0 7/ x 0 15
Drawing Type: Construction Authorization
Page 3 of 3
P1 P2
CONSTRUCTION For office use Only
AUTHORIZATION *cDP File Number 198364-1'
•'' Davie County Health Department County ID Number: B3 -m -OD -034-06
210 Hospital Street Evaluated For. EXPANSION
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 1 2/ 0 7/ 2 0 2 0
Applicant: Eric Wilkins Property Owner: Eric Wilkins
Address:
5060 US Hwy 601 N
Address:
5060 US Hwy 601 N
City:
Mocksville
City:
Mocksville
State/Zip:
NC 27028
State/Zip:
NC 27028
Phone #:
(336) 215-7673 1)
�Phone #
(336) 215-7673
Address/Road M
5060 US Hwy 601 North
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
*Water Supply: N/A
Subdivision:
Classification: Provisionally Suitable
Saprolite System?. OYes (J)No
Design Flow: 4 8 0
Soil Application Rate: 0 a 7 5
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 25%4 REDUCTION
Nitrification Field
1 7 4 5 Sq. ft.
Phase: Lot:
Directions
Hwy 601 North past Hwy 801 Intersection past
Chinquapin Rd. 5th drive on right Bick house with large
oak trees
Minimum Trench Depth: a 4 Inches \
,
Minimum Soil Cover. 1 a
Inches
Maximum Trench Depth: 3 5
Inches
Maximum Soil Cover: 1 4
Inches.
*Distribution Type: PUMP TO GRAVITY
Septic Tank:
G allons
1 -Piece: QYes 0 N
Pump Required: (J)Yes ONo OMay Be Required
Pump Tank: 1 0 0 0 Gallons
No. Drain Lines 4 1 -Piece: OYes ®No
Total Trench Length: 4 3 6 ft, GPM—vs— ft. TDH
Trench Spacing:. _ 9 0Inches O.C. Dosing Volume: _ Gallons
Feet O.C.
Trench Width:Inches
3 . Feet Grease Trap: Gallons
Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -11
Septic Tank InstallerGrade Level Required: 01 Oil 0111 OIV
Donn 4 0%f4
CDP File Number .198364-1 County ID Number. 1213-00o-00-034,06
❑ Open Pump System Sheet
Required:@Yes. ONO ONO, but has Available S
*Site Classification: Provisionally Suitable
Design Flow: 4 8 0
Soil Application Rate: 0 - a 7 5
*System Classification/Description:
TYPE 111 B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 250% REDUCTION
Nitrification Field 1 7 4 5
Sq. ft.
No. Drain Lines 4
Total Trench Length: 4 3 6
ft:
Trench Spacing:
9 0 0.
Feet InchesO.C.
Trench Width:
0 Inches
3 Feet
Aggregate Depth:
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover
1
a
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover:
a
_ 4
Inches
*Distribution Type:
PUMP TO GRAVITY
Pump Required: @Yes 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.
i
*Permit Conditions
The issuance of this permit bythe 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. ;
f
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of,the Improvement Penni% not
to exceed five years, and may be issued atthe'sametime the Improvement Permit Issued (NCG5130A-336(11)} It the Installation has not been
completed during the period of validity of the Construction Permit, the information submitted In application for a permit or Construction
Authorization Is found to have been Incorrect falsified or changed, or the site Is altered, the permit orConstructlon Authorization shall become
Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible torassuring 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 a / 0 7 / a 0 1 5
Authorized State Agent_ Malfunction Log OYes
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of
CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number 198364-1
210 Hospital Street 83-000-00-034-06
P.O. Box 848 County File Number:
Mocksville NC 27028 Date:1 2/ 0 7 12 0 1 5
Olnch
D, raving Drawing Type: Construction Authorization Scale:. OON/A k
L
CP fl
i
- F4i,
C�
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P 0 8 848
CDP File Number: 198364 -1
. . ox 83.000.00.034.01
Mocksville NC 27028 County File Number.
Date: _1 2/ 07 /2015
Click below to Import an image from an external location: Drawing Type: Construction Authorization
F�CE�vE,D
Phone: (336) - 753 - 6780
IVL�O Eli Are _csjo1
C/ rs-e' i ,,
Davie County Health Department
Environmental Health Section
P.O. Box 84.8
210 Hospital Strcet
Courier # : 09-40-06
MocksVille, NC 27028
ON-SI�-)�ATER,!>� (CATION
(Check One) acemen `�` Remodelin Reconnection
.06401. % p1l
'El I
Far (336) - 753-1680
Name: Phone Number 3�6 21�'i -7073 (Home)
Mailing Address: _(Work)
Detailed Directions To
& N L
Property Address:
utv' KA
41"k.5e vo" 'r
X060 U5 hw
d�cl ✓C D ✓► 6� io,,,�,-�- b'k/'.�� ���rtc� k4� jn �4
s� <
Please Fill In The Following Information
//About The EXISTING Facility:
Name System Installed Under: N-04 /J�r ? Type Of Facility:
Date System Installed (Month/Date/Year): 1 C75'0y o, Number Of Bedrooms: 2 Number Of People:
Is The Facility Currently Vacant? Yes 6D If Yes, For How Yes. Lon/n�g? j/ 1
Any Known Problems? No If Yes, Explain: Ncr� vt c w /r4� � ` real T -6t'' AaCS are
iirZ,INrvt4 1/r'f-/ �l��J flrrt_r ek(I !ie -F,,
Please Fill In The Following Information About The NEW Facility:
nn
Type Of Facility: ��(c4','f'i'Oh + koMC Number Of Bedrooms: + 2 Number of People
Pool Size: 1V Gari Size: Al /) Other:
Requested By: Date Requested: I l l 1-LL5
(Signature)
For Environmental Health Office Use Only
Approved Disapproved l l
Comments:
Environmental Health Specialist Date:
P
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Money Order #
Amount:$
Paid By: Received By:_
Account #: a Invoice #:
Date: //-/:-1•-
�t fZ11,9K Al
a
s
VY
r aye.. �.y� x 'A -A h ak,, rays x .haat a ,.
CN
* �a
z
"A .art
4 gi
t `
xV,ry y
.Y A
>r
x k ;
C d
wy '�
�-✓� t
�+pld
�5�
IF
g
s+
.Y A
>r
x k ;
C d
wy '�
�-✓� t
�+pld
Parcel #: B30000003406
Davie County, NC - Basic Estate Search
Basic Search
Real Estate Search
Tax Bill Search Sales Search
Q
Vlew Property Record
for this Parcel View Mao for this
Parcel View Tax Bill Information
Market:
Parcel #: B30000003406
Account #: 82523007
Owner Information Tax Codes
ILKINS ERIC LEE ADVLTAX - COUNTY T
060 US HIGHWAY 601 NORTH FIREADVLTAX - FIRE TAX
EOCKSVILLE NC 27028
Property Information
Land (Units/Type): 1.440 AC
[Address: 5060 N US HWY 601
Deed Information
Pate: 06/2004 Book: 00558 Page: 0816
Plat Book: Page:
Legal Description
1.608 AC HWY 601
Property Values
uldin :
99,69
BXF:
2,17
nd:
20,69
Market:
122 55
ssessed:
122 55
Deferred
Sales Information
Township
CLARKSVILLE
Local Zoning
PIN
5823072031
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00558 0816 06 2004 WD Qualified Improved 131,500
View Property Record for this'Parcel View Map for this Parcel View Tax Bill Information
« Return to Basic Search
Page 1 of 1
0V41�
t,;
Uri
Davie County Web Site
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/itsnettView.aspx?prid=1466043 8/24/2016