642 Pineville RdCONSTRUCTION
AUTHORIZATION
Davie County Health Department
210 Hospital Street
• P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Schumacher Homes of NC, Inc
Address: 6349 Buent Poplar Road
City: Greensboro
State/Zip: NC 27409
Phone #: (336) 676-3575
/ For Office Use Only
*CDP File Number 232637 - 1
County ID Number: 5843192013/5843185970
Evaluated For: NEW
Township:
PERMIT VALID UNTIL:
1 a 1 8/ a 0 a 1
Property Owner: Robert Hutchens & Shelley
Delmestizi
Address: 4182 Clemmons Rd. #222
City: Clemmons
State/Zip: NC 27012
Phone #: (941) 544-1117
Property Location & Site Information
//Address/Road #: Subdivision:
Pineville Road
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People: 2
*Water Supply: NEW WELL
Phase: Lot:
Directions
Hwy 158, left on Farmington Rd. cross Hwy 801 Turn Left
on Pineville Road
ificati
Page 1 of 3
Minimum Trench Depth:
3 Inches \
Site Classification:
Provisionally Suitable
Minimum Soil Cover:
4-
Saprolite System?
Yes X No
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:
GRAVITY - SERIAL
TYPE III G. OTHER NON-CONV. TRENCH SYSTEMS
Septic Tank:
1 0 0 0
Gallons
*Proposed System: 25% REDUCTION
1 -Piece:
O Yes (9 No
Pump Required: O Yes
(KNo O May Be Required
Nitrification Field
1 3
0
9
Sq. ft.
Pump Tank:
Gallons
No. Drain Lines
3
1 -Piece:
OYes ONo
Total Trench Length:
3 a 7
GPM --vs-- ft. TDH
ft
Trench Spacing:O
—
9
Inches O.C.
. (9 Feet O.C.
Dosing Volume:
Gallons
Trench Width:
3
0Inches
—
(8)Feet
Grease Trap:
Gallons
Aggregate Depth:
inches
Pre -Treatment: O NSF OTS -1 O TS -11
Septic Tank Installer Grade Level Required: 01011
O III 01V
Page 1 of 3
CDP File Number 232637 - 1 County ID Number: 5843192013/5843185970
Kepalr SySTem Kequirea: LJ T CS LJ IVU `J NU, UUL HdS h\vdI!dulC J
/Repair System
*Site Classification: PS Shallow Placement
Design Flow: 3 6 0
Soil Application Rate: 0 a
*System Classification/Description:
TYPE III G. OTHER NON-CONV. TRENCH SYSTEMS
*Proposed System:
25% REDUCTION
4
Inches
Nitrification Field
1 6
0
0 Sq. ft.
No. Drain Lines 5
Total Trench Length: 4 5 0
ft.
❑ Open Pump System Sheet
Trench Spacing: 9 O Inches O.
— X Feet O.C.
Trench Width: 3 (g Inches
O Feet
Aggregate Depth:
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover:
1
a
Inches
Maximum Trench Depth:
a
4
Inches
Maximum Soil Cover:
1
a
Inches
*Distribution Type: GRAVITY -SERIAL
Pump Required: OYes ONo OMay 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. Rema�r�g
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. Reaacteg
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 (.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? O Yes X NO
Applicant/Legal Reps. 64Ratu
*Issued By: 2140 - Nations, Robert
Authorized State Agent: LSC
Date:
Date of Issue: l a/ 1 8/.2 0 1 6
v
Malfunction Log Oyes
(8) Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
C
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Type: Construction Authorization
t-�
0
<:Or <��2
CDP File Number: 232637 - 1
County File Number: 5843192013/5843185970
Date: 1J/ 18/a016
Q Inch
Scale: O Block
Q N/A
—711
--e
a
--",_
Page 3 of 3
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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:
232637-1
5843192013/5843185970
Date: 1 a/ 18 / a 0 16
Drawing Type: Construction Authorization
Page 3 of 3
P1 P2