492 Junction RdOPERATION PERMIT
Davie County Health Department
° ¢ 210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Barry Sechrest
Address: 1440 North Main Street
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 909-0370
Property Loca
Address/Road #: Subdivision:
492 Junction Road
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People: 5
*Water Supply: PUBLIC
*IP Issued by:
*CA Issued by: 2325 - Mitchell, Brittany
Design Flow: 3 6 0
Soil Application Rate: 0 1 7 5
Nitrification Field
No. Drain Lines
Total Trench Length
Trench Spacing:
Trench Width:
Aggregate Depth:
*CDP File Number 235000 - 1
5726691841
County ID Number:
Evaluated For: REPAIR
�ownship:
/Property Owner: Barry Sechrest
Address: 1440 North Main Street
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 909-0370
ion & Site Information
Phase: Lot:
Jericho Church Rd. Left on Junction, home on right
*System Classification/Description:
TYPE III G. OTHER NON-CONV. TRENCH SYSTEMS
Saprolite System? XiYes ,',,No
*Distribution Type: GRAVITY -SERIAL Pump Required?
0 Yes X No
*Pre -Treatment:
Drain field
1 4 8 8 Sq. ft.
6
496ft.
9 0Inches O.C.
®Feet O.C.
3 6 IgInches
0 Feet
inches
Minimum Trench Depth:
3
a
Inches
Minimum Soil Cover:
a
0
Inches
Maximum Trench Depth:
3
a
Inches
Maximum Soil Cover:
a
0
Inches
Page 1 of 4
*System Type: INFILTRATOR QUICK STANDARD
Installer: Ben Crotts
Certification #: 1058
*EHS: 2325 - Mitchell, Brittany
Date: 5/ 1 6/.1 0 1 7
Approval Status
0 Approved ❑ Disapproved
CDP File Number 235000 - 1
/ Manufacturer: shoat
STB: 760
Gallons: 1000
Date: 3/ a 5/ a 0 1 7
*Filter Brand:
ST Marker: ❑ Yes ❑ NO
Reinforced Tank: ❑ Yes ❑ No
\ 1 Piece Tank: ❑ Yes ❑ NO
Manufacturer:
Pump Type:
PT:
Gallons:
Date:
/
Riser Sealed
❑ Yes
Riser Height:
❑ Yes
Reinforced Tank:
❑ Yes
\ 1 Piece Tank:
❑ Yes
/ Pipe Size:
Pipe Length:
*Schedule: 40
Pressure Rated ❑ Yes
Approved fittings ❑ Yes
❑ No
❑ No (Min. 6 in.)
❑ No
❑ No
County ID Number: 5726661841
clog UT17 7
Lat.
Long:
Installer: Ben Crotts
Certification #: 1058
*EHS: 2325 - Mitchell, Brittany
Date: 5/ 1 6/ x 0 1 7
Approval Status
❑X Approved ❑ Disapproved
Pump Tank
Installer: Ben Crotts
Certification #: 1058
*EHS:
Date:
Approval Status
❑ Approved ❑ Disapproved
Supply Line
4 inch diameter Installer: Ben Crotts
5feet Certification #: 1058
*EHS: 2325 - Mitchell, Brittany
❑ No Date: 5/ 1 6/ a 0 1 7
❑ No Approval Status
❑X Approved ❑ Disapproved
/
Pump Type:
Dosing Volume:
-
Draw Down:
Inches
*Chain:
Valves Accessible
❑
Yes
❑
No
Flow Adjustment Valve
❑
Yes
❑
No
Check -valve
❑
Yes
❑
No
PVC Unions
❑
Yes
❑
No
Vent Hole
❑
Yes
❑
NO
Anti -siphon Hole
❑
Yes
❑
No
Installer: Ben Crotts
Gal Certification #: 1058
*EHS:
Page 2 of 4
Date:
Approval Status
❑ Approved ❑ Disapproved
CDP File Number 235000 - 1
County ID Number: 5726691841
NEMA 4X Box or Equivalent
❑
Yes
❑
NO
Installer:
Ben Crotts
Box 12 inches Above Grade
❑
Yes
❑
NO
1058
Certification #:
Box Adj. To Pump Tank
❑
Yes
❑
No
Conduit Sealed
❑
Yes
❑
NO
*EHS:
Pump Manually Operable
❑
Yes
❑
No
*Activation Method:
Date:
Approval Status
Alarm Audible
El
Yes
ElNo
❑Approved
❑ Disapproved
Alarm Visible
El
Yes
ElNO
2325 - Mitchell, Brittany
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 5/ 1 6/.1 0 1 7
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 111 G. sewage septic system.
Rule .1961 requires that a Type TYPE 111 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
Drawing Drawing Type: Operation Permit
CDP File Number: 235000 - 1
County File Number: 5726691841
27028 Date: / /
O Inch
Scale: O Block
O N/A
Page 4 of 4 P1 P2 P3
t3u�� c,�„
—
)30r ,
i
)D r O r
t
67,
o'
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
5726691841
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