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2868 Hwy 64E { OPERATION PERMIT or nice use Only q Davie County Health Department 'RCDP File Number 137271 -1 210 Hospital Street J7-000-00-075 P.O.Box 848 County ID Number. Mocksville NC 27028 Evaluated For REPAIR Phone:336-753-6780 Fax:336-753.1680 Township: Applicant: Teddy Boger Property owner: Teddy Boger Address: 2868 US Hwy 64 East Address: 2868 US Hwy 64 East .City: Mocksville City: Mocksville State0p: NC 27028 'State/Zip: NC 27028 Phone#: (336)998-2007 Phone#: (336)998-2007 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 2868 US Hwy 64 East Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy.64 East, passt Merrell's Lake Road on left at top of hill on right before Homestead Lane #of Bedrooms: 3 #of People: 2 -Water Supply: PUBLIC -IP issued by. *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) -CA issued by: 2140.Nations,Robert SaproliteSystem? QYes QNo Design Flow: 3 6 0 - GRAVITY-SERIAL Pump Required? 'Dist OYes ONo Soil Application Rate: 0 a 7 S 'Pre Treatment: Drain field Nitrification Field 1 3 0 9 Sq.ft. -System Type: INFILTRATOR QUICK 4 STANDARD No. Orcin Lines 4 Installer: Randy Miller Total Trench Length: 3 4 0 It. Certification#: 1128 Trench Spacing: _ 9 Inches O.C. g(j)Feet O.C. 'EHS: 2140-Nations.Robert Trench Width: _ 3 Olnches ( Feet Date: 0 8 / 1 3 / 2 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 4 Approval Statu Inches s Maximum Trench Depth: 3 6 Inches ® ApproVetl O Disapproved Maximum Soil Cover. 2 4 Inches CDP File Number 137271 - 1 County ID Number: J7-000-00.075 Septic Tank Manufacturer. Lat. Long: . STB: Gallons: Installer. Date: Certification#: *EH S: *Filter Brand: ST Marker. ❑ Yes ❑ No Date: , Reinforced Tank: El Yes ❑ No Approval Status Piece Tank: [3 Yes El No -❑ Approved❑ Dlsapprov�d Pump Tank Manufacturer. Installer. PT: Certification#: Gallons: *EH S: -...Date: Date: RiserSealed ❑ Yes ❑ No RiserHeght: ❑ Yes ❑ No (Min.6,in.) y AppStat roval us 71.Pie forcedTank: ❑ Yes O NoQ Approved❑ Disapprovedce Tank: ❑ Yes O No Supply Line Pipe Size: inch diameter Installer: Pipe length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings [:1 Yes El No Approval Status ❑ Approved -0 Disapproved _, Pump e e Pump Type: Installer. Dosing Volume: — Gal Certification#: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve El Yes ❑ No ApprovalStatus PVC unions El Yes El No ❑ Approved❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole [I Yes ❑ No • CDP File Number 137271 - 1 County ID Number: .7-000.00.075 Electric Equipment NEMAUBox or Equivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ NO Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'EHS: Pump Manually Operable ❑ Yes ❑ No 'Activation Method: Date: Approal Status Alarm Audible ❑ Yes ❑ NO Approved❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140-Nations,Robert 'Operation Permit completed by: Authorized State Agent: Date of Issue: 0 8 / 1 3 / 2 0 1 4 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 by a TYPE 11 A sewage septic system. Rule.1961 requires that a Type,.TYPE 11,k septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified 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 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 entitywith 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. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** ` OPERATION PERMIT 137271 1 Davie County Health Department CDP File Number: 210 Hospital Street J'7-000.00.075 P.O.Box 848 County File Number; Mocksville NC 27028 Date: Olnch Drawing Drawing Type: Operation Permit Scale. ' ON A k CIT VV l � I I k l I i CONSTRUCTION For Office`Use Only AUTHORIZATION *CDP File Number 13727171 Davie County Health Department County ID Number: 17-000-00-075 210 Hospital Street Evaluated For. REPAIR P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 4 / 1 1 / 2 0 1 9 Applicant: Teddy Boger Property Owner: Teddy Boger Address: 2868 US Hwy 64 East Address: 2868 US Hwy 64 East City: Mocksville City: Mocksville State2ip: NC 27028 State0p: NC 27028 Phone#: (336)998-2007 Phone 9: (336)998-2007 Property Location & Site Information Address/Road #: Subdivision: Phase: Lot: 2868 US Hwy 64 East Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 64 East, passt Merrell's Lake Road on left at top of #of Bedrooms: 3 hill on right before Homestead Lane 9 of People: 2 `Water Supply. PUBLIC System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally Suitable Inches Minimum Soil Cover. Saprolite System? OYes @No 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: Maximum Soil Cover: a 4 0 . a 7 5 1110bes *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Gallons *Proposed System: 25%REDUCTION 1-Piece: OYes O N o Pump Required: OYes QNo OMay Be Required Nitrification Field 1 3 0 9 Sq. ft. Pum Tank: Gallons No. Drain Lines 3 1-Piece: OYes ONo. Total Trench Length: 3 a 7 ft GPM—vs-- ft. TDH Trench Spacing: _ 9 @Inches O.C. g Dosin Volume: _ Gallons Feet O.C. Trench Width: _ 3 0IInches Feet Grease Trap: Gallons 1 Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01 Oil 0111 01V J7-000-00-075 • CDP File Number 137271 - 1 County ID Number: ❑ Open Pump System She( Repair System Required:OYes ONo ONo, but has Available Space epa'tr System Trench Spacing: Inches 0.C- 'Site Classification: 8 Feet O.C. Trench Width: Inches Design Flow: — Feet 8 Soil Application Rate: Aggregate Depth: inches _.__. Minimum Trench Depth: 'System Classification/Description: Inches Minimum Soil Cover. Inches Maximum Trench Depth: Inches *Proposed System: Maximum Soil Cover: Nitrification Field Inches Sq- ft. No. Drain Lines 'Distribution Type: Total Trench Length: ft Pump Required: OYes ONo OMay Be Required Pre-Treatment: ONSF 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. '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. 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 sametime the Improvement Permit issued(NCGS 930A-335(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(.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 Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature, Date: *Issued By: 2140-Nations,Robert Date of Issue: . 0 4 1 1 0 1 4 Authorized State Agent: j Malfunction Log Oyes C�fand Drawing 0Import Drawing **Site Plan/Drawing attached.** CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 137271 - 1 210 Hospital Street P.O.Box 848 . County File Number: ��-000-oo-ops Mocksville NC 27028 Date: 04 / 1 1 / x 0 1 4 Q Inch DrawingDrawing Type: Construction Authorization Scale: Q61ock = ()N/A 0 Show Property page Page 1 of 1 Camolina Health ental R Show Property Cancel File 137271 „e / Status ACTIVE / County Davie Subdivision or Property? PROPERTY D Parent PIN J7-000-00-075 Plat Date Address 1 2868 US Hwy 64 East Address 2 City/State/Zip Mocksviile North Carolina 27028 Township Subdivision Block/Lot/Section Lot Size 2.41 ACRES Zoning Setback Front/Back Setback Left/Right Latitude/Longitude Directions Hwy 64 East,passt Merrell's Lake Road on left at top of hill on right before Homestead Lane Comments Setup/Last Update 419=14 4/912014 Current Applicant Teddy Boger ;Owner Information Name Teddy Boger Address 1 2868 US Hwy 64 East Address 2 I City/State/Zip Mocksvilie NC 27028 Home I Work/Cell Phone (336)998-2007 (336)813-8139 Ok Copyright©2012 Custom Data Processing,Inc.All rights reserved.(ncenvosw version 2.1.20 3/4/2014 isd8.0.2 db=kyprodl) https://portal.cdpehs.com/NCENVOSW/OSW PROPERTY/ShowOSW PROPERTYRecor... 4/9/2014 rr d .�__ ; • DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR nn Q c/ Name Telephone Number-5-3 8C5 3 0 xJ F Address Mailing Address (if different from above) Email Address: Subdivision Name Lot# Directionsji dAl iah b r 3'7-D00- a- �.� D N Date System Installed L{U 5 Name System Installed Under Type Facility 1-41imber Bedrooms_ Number People Served -'- Type Water Supply ce Specific Problem Occurring Date Requested !!5�— 4/^ Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE,AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason Revised 2-2011 l ppr'afsal Card Page 1 of 1 DAVIE COUNTY NC 4/4/2014 2:35:50 PM OGERTEDDYWAYNE BOGERDORIS Retum/Appeal Notes: Parcel:37-000-00-075 868 E US HWY 64 PLAT:/ UNIQ ID 19619 302299 D359-P6 ID NO:5767881774 Own( COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1 eval Year:2013 Tax Year:2014 2.58 AC HWY 64 2.410 AC SRC-InspeCtion kppralsed by 07 on 07/27/2007 04002 CEDAR GROVE CHURCH TW-04 CI- FR-09 EX- AT- LAST ACTION 20130624 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OFVALUE oundation-3Floor System -4 Eft BASE ub FloStandard 0.3300 ntous 5.0 S 0 Area QUA RATE I RCN jEYBjAYB REDENCE TO MARKET Ilywood 8.00 01101 11,8521 102 71.40 132233 198 194 %GOOD 1 67.0 DIEPR.BUILDING VALUE-CARD 88,60 Exterior Walls-10 TYPE:Single Family Residential Single Family Residential EPR.OB/XF VALUE-CARD Iuminum/Vin 1 Siding 29.00 4ARKET LAND VALUE-CARD 31,00 fing Structure-03 STYLE:2-1.5 Shlries DIAL MARKET VALUE-CARD 119,60 ble 8.0 oofing Cover-03 s halt or Composition Shingle 1 TOTAL APPRAISED VALUE-CARD 119,60 nterior Wall Construction-5 TOTAL APPRAISED VALUE-PARCEL 119,60 )rywall/Sheetrock 20.0 nterlor Floor Cover-08 TOTAL PRESENT USE VALUE-PARCEL heet Vinyl/Laminate 8.0c TOTAL VALUE DEFERRED-PARCEL nterior Floor Cover-09 TOTAL TAXABLE VALUE-PARCEL 119,60 'ne or Soft Woods 0.0 sting Fuel-03 PRIOR s 1.0c 3UILDING VALUE 92,54 eating Type-SO 3BXF VALUE eat Pump 4.0 ND VALUE 29,20 it Conditioning Type-03 RESENT USE VALUE ntral 4.0 EFERRED VALUE edrooms/Sathrooms/Fmlf-Bathrooms TAL VALUE 121,74( /1/0 8.00 edrooms AS-3FUS-0LL-O athrooms PERMIT AS-1 FUS-0 LL-0 CODE I DATE I NOTE I NUMBER AMOUNT If-Bathrooms AS-0FUS-0LL-O rce +--15--+----28-----t +-12-+ OUT:WTRSHD: AS-OFUS-OLL-O IWDD IBAS I IFUS I SALES DATA 1 I 1 1 1M,971 INDICATE OTAL POINT VALUE 8.00 4 2 1 1 1 DEED SALES BUILDING ADJUSTMENTS +----27----+5-+ 2 I I I IFGD I I I I IR TYPE PRICE ali 3 AVG 1.000 1 8 1 3 3 301 QC E I SO hs Desi 4 FACTOR4 1.050 1 +10-+ 8 8 8WD U 1 7100 iza 1 3 1 Size 10.990C 8 1 U E P 1 I I I DIAL ADJUSTMENT FACTOR l.G4C I O 0 I I 1 OTAL QUALITY INDEX 10 +-----32------+SO-+ I I I i 6 I I I �• +10-+6-+-12-+ +-12-+ HEATED AREA 1,520 SFOP +6-+ NOTES WNER 3 SIDING SUBAREA UNI I ORIG% ANN DEP 96 OB/XF DEPR GS DE ESCRIPTION OUN T N PRICE GOND LDG*AYB EYB RATE V COND VALUE TYPE AREA %RPL CS 5 ARN1 1 301 4CI 1,20CI 15.00 01 1196qI9601S31 1 01 0 AS 1,010 7597 OTAL OB XF VALUE GD 57 4 1849 OP 3 3 78 S 45 9 2927 EP 10 5 357 [DD 29 2 414LACE 1-None REA 2,51 132,23 LS DING DIMENSIONSBAS=W28 WDD=W15514ESS8ElON22$S22 UEP4V10 FGD=N8W32S18E32N10$S10E10N10$S16EIOFOP�SE6NSVb$E18N38$7TR=E10 E12S38W12N38$W30$. INFORMATIONEST TNERAD3USTMENTS TOTAL BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND OVERRIDE LAND CODE ZONING TAGE EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNITPRICE VALUE VALUE NOTES L AC 0120 229 0 1.6240 4 1.1500+03+12+00+00+00 PW 6,900.0 2.40 AC 1.86 12,889.2 30999 C L MARKET LAND DATA 2.40 31,00L PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=J700000075 4/4/2014