The URL can be used to link to this page

163 Baltimore Downs Rd Lot 10OPERATION PERMIT Davie County Health Department ° ¢ 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Reliant Homes Address: PO Box 968 City: King State/Zip: NC 27021 Phone #: (336) 757-6068 *CDP File Number 231001 - 1 5860737680 County ID Number: Evaluated For: NEW �ownship: /Property Owner: Reliant Homes Address: PO Box 968 City: King State/Zip: NC Phone #: (336) 757-6068 Property Location & Site Information Address/Road #: Subdivision: Baltimore Downs 163 Baltimore Downs Rd Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP Issued by: 2140 - Nations, Robert *CA Issued by: 2140 - Nations, Robert Design Flow: 4 8 0 Soil Application Rate: 0 a Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: 27021 Phase: Lot: 10 Hwy 158, right on Baltimore Rd. right into Baltimore Downs *System Classification/Description: TYPE III G. OTHER NON-CONV. TRENCH SYSTEMS Saprolite System? J Yes X, No *Distribution Type: PUMP TO GRAVITY Pump Required? X Yes 0 No, *Pre -Treatment: Drain field a 4 0 0 Sq. ft. 5 600ft. 9 0Inches O.C. (9 Feet O.C. 3 OInches (9 Feet inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover: a 4 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: ) 4 Inches Page 1 of 4 *System Type: INFILTRATOR QUICK STANDARD Installer: Frank Transou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 0 5/ 0 4/.1 0 1 7 Approval Status X❑ Approved ❑ Disapproved CDP File Number 231001 - 1 Manufacturer: shoat STB: 763 Gallons: 1000 Date: 0 a/ a 7/ a 0 1 7 *Filter Brand: POLYLOK PL -122 With Pipe Adapter ST Marker: ❑ Yes ❑X No Reinforced Tank: ElYes ❑X ❑X No \ \Piece Tank: ❑ Yes ❑X No Manufacturer: shoat County ID Number: 5860737680 septic i anK Lat. PT: 63 Installer: Gallons: 1250 Date: 0 a/ a 7/ a 0 1 7 Riser Sealed ❑X Yes ❑ NO Riser Height: ❑X Yes ❑ No (Min. 6 in.) Reinforced Tank: ❑X Yes ❑ No \ 1 Piece Tank: ❑X Yes ❑ NO / Pipe Size: a inch diameter Pipe Length: 1 9 5 feet *Schedule: 40 Pressure Rated X❑ Yes Approved fittings X❑ Yes Long: In Installer: Frank transou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 0 5/ 0 4/ x 0 1 7 Approval Status ❑X Approved ❑ Disapproved Pump Tank Installer: Frank Transou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 0 5/ 0 4/ a 0 1 7 Approval Status ❑X Approved ❑ Disapproved Supply Line Installer: Frank Transou Certification #: 2771 *EHS: 2140 - Nations, Robert ❑ No Date: 0 5/ 0 4/ a 0 1 7 ❑ No Approval Status ❑X Approved ❑ Disapproved / Pump Type: zoeier Installer: Frank Trasou Dosing Volume: - Gal Certification #: 2771 Draw Down: 4 5 Inches *EHS: 2310 - Debra Harmon *Chain: ROPE 0 5 / 0 4 / a 0 1 7 Date: Valves Accessible ❑X Yes ❑ No Flow Adjustment Valve X Yes ❑ No Check -valve ❑X Yes ❑ No Approval Status PVC unions X Yes ❑ No X Approved ❑ Disapproved Vent Hole ❑X Yes ❑ NO Anti -siphon Hole ❑X Yes ❑ No Page 2 of 4 CDP File Number 231001 - 1 County ID Number: 5860737680 NEMA 4X Box or Equivalent 0 Yes ❑ NO Installer: Frank Transou Box 12 inches Above Grade 0 Yes ❑ NO 2771 Certification #: Box Adj. To Pump Tank ❑X Yes ❑ No Conduit Sealed 0 Yes ❑ NO *EHS: 2140 - Nations, Robert Pump Manually Operable 0 Yes ❑ No *Activation Date: 0 5/ 0 4/ x 0 1 7 Method: PIGGYBACK Alarm Audible ® Yes Alarm Visible 0 Yes *Operation Permit completed by_ Authorized State Agent: Owner/Applicant Signature: Approval Status El No El No 0 Approved ❑ Disapproved 2140 - Nations, Robert Date of Issue: 0 5/ 0 4/.1 0 1 7 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 by a TYPE iii G. sewage septic system. Rule .1961 requires that a Type TYPE iii G. 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. 9 Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 3of4 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Operation Permit CDP File Number: 231001 - 1 County File Number: 5860737680 Date: / / O Inch Scale: O Block n�O N/A J VV% a l2c n 1 JN -co I � D J3d 1 ;L Cl; I 6A /- � I M, b ft ' 5� P Page 4 of 4 P1 P2 / P3 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC CDP File Number: 27028 County File Number: Date:. . / Click below to import an image from an external location: Drawing Type: Operation Permit 5860737680 Page 4 of 4 P1 P2 P3 Drain Field: System Final Inspection Log: Characters Remaining 4000 Septic Tank: Pump Tank: Supply Line: Pump Requirements: Electrical Equipment: P1 P2 P3 Characters Remaining 4000 Characters Remaining 4000 Characters Remaining 4000 Characters Remaining 4000 Characters Remaining 4000 .. CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 231001 -1, Davie County Health Department County ID Number:5860737680 210 Hospital Street Evaluated For: NEW .� ,. P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 1 0 / a 5 / a 0 a 1 Applicant: Reliant Homes Property Owner: Reliant Homes Address: PO Box 968 Address: PO Box 968 City: King City: King _ State0p: NC 27021 StatefZip: NC 27021 Phone#: (336)757-6068, Phone#: (336)757-6068 Property Location &Site Information Address/Road #: Subdivision: Baltimore Downs Phase: Lot: 10 163 Baltimore Downs Rd Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158, right on Baltimore Rd. right into Baltimore Downs #of Bedrooms: 4 #of People: "Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 (Design lassification: Provisionally Suitable Inches Minimum Soil Cover. ite System? QYes ONo 1 a Inches Flow: 4 8 0Maximum Trench Depth: a 4 Inches Soil Application Rate: a Maximum Soil Cover: 1 a Inches "System Classification/Description: 'Distribution Type: PUMP TO GRAVITY TYPE III G.OTHER NON,CONV.TRENCH SYSTEMS Septic Tank: 1 0 0 0 _ Gallons 'Proposed System: 25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes ONo OMay Be Required Nitrification Field x 4 0 0 Sq. ft. Pump Tank: 1 0 0 0 Gallons No. Drain Lines 4 1-Piece: OYes QNo Total Trench Length: 6 0 0 ft GPM—vs-- ft. TDH Trench Spacing: — 9 @Feet O.C.lnches O.C. Dosing Volume: _ Gallons Trench Width: Inches 3 gFeet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: OI Oil 0111 OIV Desnn 1 of Q CDP File Number 231001 - 1 County ID Number. 580737680 ❑ Open Pump System Sheet Repair System Required:OYes ONO ONO, but has Available Space rDesign System Trench Spacing: 9 Inches O.0 ification: Provisionally Suitable Feet O.C. Trench Width: Inches w: 4 8 0 _ &Feet Soil Application Rate: Aggregate Depth: 0 a inches W � "System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS Minimum Soil Cover. 1 a Inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: a 4 Inches Maximum Soil Cover. 1 a Nitrification Field a 4 0 0 Inches Sq.ft. No. Drain Lines -6 *Distribution Type: PUMP TO GRAVITY Total Trench Length: 6 0 0 Pump Required: ( Yes 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. A "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. ; 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 sarin a time 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,o'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,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 0 / a 5 / a 0 1 6 Authorized State Agent: .�' Malfunction Log OYeS @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street 5860737680 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 1 0 / 2 5 / 2 0 1 6 Q Inch Drawing Drawing Type: Construction Authorization Scale: , OBlock QN/A I I I c l1 co 516 1µ ls-rsI � I �a I 1 r 5 ' I I 1-4�_._._._ CONSTRUCTION AUTHORIZATION ' Davie County Health Department 210 Hospital street CDP File Number: P.O.Box 848 5860737680 Mocksviile NC 27028 County File Number: Date: 10 / 25 / 2 0 1 6 Click below to import an Image from an external location: Drawing Type:Construction Authorization IMPROVEMENT PERMIT For Office use only 'CDP File Number 231001 -1 Davie County Health Department 210 Hospital Street County ID N um ber.5860737680 Evaluated For. NEW P.O.Box 848 Mocksville NC 27028 Township: Phone: 336-753-6780 Fax:336-753-1680 PERMITVALID UNTIL 10/25/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Reliant Homes rAddress: erty owner: Reliant Homes Address: PO Box 968 PO Box 968 City: King King State/Zip: NC 27021 State/Zip: NC 27021 -Phone#: (336)757-6068; Phone#: (336)757-6068 Property Location & Site Information Address/Road#: Subdivision: .681timore Downs Phase: Lot: 10 163 Baltimore Downs Rd Advance NC 27006 Directions Structure: -:.':SINGLE FAMILY- Hwy,158, right on Baltimore Rd. right into Baltimore #of Bedrooms: 4 Downs #of People: *Water Supply: PUBLIC System Specifications �Glassiticatio �System "Sitn: Provisionally suitable Minimum Trench Depth: a 4 Inches Seprolite System? (Dyes QNo Maximum Trench Depth: a 4 Inches Tank: T Septic an Design Flow: 4 8 0 S_ _ 1 0 0 0 Gallons Soil Application Rate: 0 2 1-Piece: QYes ,QNo Pump Required: QYes 0 N OMay Be Required *System Classification/Description: TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS Pump Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes �)No Repair System Required:OYes ONO ONo, but has Available Space Cs Repair System ite Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inchesil Application Rate: 0 a Maximum Trench Depth: a4 Inches u *System Classification/Description: Pump Required: @Yes QNo Q Maybe Required TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 231001 - 1 County ID Number; 5860737680 'Site Modifications ❑ Open Fill Sheet 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 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. Site Plan The Improvement Permit shall be valid for 6 years from date of Issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the site for the proposed wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale atone inch equals no more than 60 feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat - also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit is subject to revocation if the site plan,plat or intended use changes(NCGS 130A-335(f)).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: "Issued ey: 2140-Nations,Robert Date of Issue: 1 0 / a 5 / a 0 1 6 Authorized State Agent: OValid without Expiration? OCreate CA. 91-land Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 231001 - 1 Davie County Health Department CDP File Number: 210 Hospital Street 5860737680 P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: QBlock QNlA -� o v "p_ -- LL 6 !L J � a 0 i ► n__ n _sn IMPROVEMENT PERMIT , Davie County Health Department 210 Hospital street CDP File Number: 231001 - 1 P.O.Box 848 5860737680 Mocksville NC 27028 County File Number: Date: 1 0 / 2 5 / 2 0 1 6 Click below to import an image from an extemal location: Drawing Type: Improvement Permit APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health i� P.O:Box 848/210 Hospital Street MocksvIlle,NC 27028 (336)753-6780/Fax(336)753-1680 Application For. 90 Site valuation/Improvement Permit E Authorization To Construct(ATC) ❑Both Type of Application: ew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT'**THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION - NametobcBilled Re1�:,_k 4o,-Lo Contact Person kA&AJ-n Billing Address Po. B o x R t 8 Home Phone ' City/State/ZIP JCL—s5 I A) ,'74-L I Business Phone 33G''�57'6o6'g Name on Permit/ATC if Dii9erent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facil!&Comers Flagged i to - NOTE: A survey plat or site plan must accompany this application. Included:9Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat) Owner's Name RZ CkL:-t hone Number 3 3 - 7S7-4ob Owner's Address. P.a. 0 bK 9b?o City/State/Zip t_1:.„ ,v(_ Property Address N3 City AJV4—ce Lot Size B.oS TaxPIN# s860- 73- 7(e8( Subdivision Name(ifapplicable) fir(_4L Section/Lot# t� _Directions To Site: 13_tk.,�_rt tea” d.,d,n;,rc Oo..n1 t2a.�p r •-- =- If the answer to any of the following questions is"yes",supporting documentation must be attached Are there any existing wastewater systems on the site? Dyes 01Nb Does the site cdntain jurisdictional wetlands? ❑Yes 6wo Are there any easements or right-of-,ways on the site? ❑Yeso Is the site subject to approval by another public agency? Dyes 151140 Will wastewater other than domestic sewage be generated? ❑Yes 04o _ IF RESIDENCE FILL OUT THE BOX BELOW =- #People #Bedrooms- 4 #Bathrooms Garden Tub/Whirlpool i4es ❑No Basement:❑Y�o Basement Plumbing: @Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Scats I Type system requested: ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:Ef County/City Water ❑New Well ❑Existing Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes &,110 If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws nd rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and I a fl g ' or eking the house/facility location,proposed well location and the location of any other amenities. • roperty owner's or owner's legal representative signature • Site Revisit Charge // Date(s): Client Notification Date: Dae EHS: i Sign given Dyes f]No Account# /001 I Revised 11/06 Invoice# SETBACKS: FRONT: 40' SIDE: 15' SIDE(STREET): 25' SFTe �. REAR: 30' STACEY L. BUTLER D.B. 419 PG. 772 ------ , ------------- ----------------- ---- ___ ----_--__. POWER PG.293 ESM --------- — as ; OUKE p.8.60 PG.293 ---f — / �— --_ _ _---- F ------ / ------ , ------- 33.05' y 6.06'�Ao, 14.64' PROPOSEDCA - RESIDENCE 1 N 'O '9.79 11.79' , I 13.00' 1 - i l 2i 11. 10. 0. T 11.75 y 3' 11.17 LO HOME DIMENSION NTS 1 / 1 / 1 / I / 1 , , 1 / I / 84.43' '®'a 83 10' �,,,,, , PRELIMINARY ! EW PLOT PLAN FOR: RELIANT HOMES `- - LOT 10 OF BALTIMORE DOWNS •----- P.B. 8 PG. 150 BALTIMORE DOWNS ROAD GRAPHIC SCALE t80 0 so ISO 320 Flaming69inceringt Inc. 8518 Triad Drive Colfax,NC 27235 ( IN FEET ) Phone:336.851.9797,Fax: 336-852.9766 1 inch = 160 ft. NCBELS C-0950 DATE: 09-23-2016 REF: PROJ\Reliant Homes\Drawings\Baltimore Downs.dwg