The URL can be used to link to this page

521 Ridge Rd OPERATION PERMIT orse n v rte. Davie County Health Department *CDP File Number 197812-1 210 Hospital Street P.O.Box 848 County ID Number. Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Collins Home Builders, Inc r operty owner. Drew Ridenhour Address: 971 Markland Road ddress: Ridge Road Cty: Advance ity: Mocksville State/zip: NC 27006 :State/Zip: NC 27028 Phone#: (336)345-3992 Phone#: (336)909-1416 Propeqy Location & Site Information r dress/Road Subdivision: Phase: Lot: Ridge Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY 1-40 West exit Hwy 64 Left on 64, right on Greenhill Rd, right Davie academy turns into Ridge Road lot is #of Bedrooms:. 4 on the left #of People: *Water Supply: PUBLIC *IP Issued by. "System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? QYes QNo Design Flow: 4 8 0 * GRAVITY-SERIAL Pump Required? Distribution Type: QYes @No Soil Application Rate: 0 . a "Pre-Treatment: Drain field rNoRrnification Field a 4 $ 0 Sq.ft. "System Type: INFILTRATORQUICK45TANDARD rain Lines 4 Installer: Jamie Barnes Total Trench Length: 6 0 0 ft. Certification#: 1018 Trench Spacing: — 9 Inches O.C. Feet O.C. *EH S: 2140-Nations.Robert Trench Width: 3 Inches — gFeet Date: 0 8 / 1 7 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4Inches Approval Status Maximum Trench Depth: 3 6 Inches ®: Approved Cl Disapproved Maximum Soil Cover. a 4 Inches CDP File Number 197812 - 1 County ID Number: Septic Tank Manufacturer. Shoaf Lat. STB: 760 Long: Gallons: 1000 Installer. Jamie Games Certification#: 1018 Date: 0 5 / 1 3 / .2 0 1 6 ` *EHS: 2140-Nations,Robert *Filter Brand: POLYLOK PLA 22 With Poe Adapter ST Marker: ❑ Yes 2 No Date: 0 8 J 1 7 / a 0 1 6 Reinforced Tank: ❑ Yes M No Approval Status 1 Piece Tank: ❑ Yes ® No ® Approved❑ .Dlsapproved _ Pump Tank Manufacturer: Installer. - PT: Certification#: Gallons: *EHS: Date: / / Date: RiserSealed ❑ Yes ❑ No RiserHetght: ❑ Yes ❑ No (Min.6 in.) Approval Status Reinforced Tank: El Yes , ❑ No ❑ Approved❑ Disapprovet 1 Piece Tank: ❑ Yes ❑ No ,. .,,. , . ,,, Supply line Pape Size: inch diameter Installer: Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: / J Approved fittings ❑ Yes ❑ NoApproval Sta11, Antus ❑ Approaed❑ Disapproved Eump Requirement Pump Type: Installer. Dosing Volume: — Gat Certification#: Draw Down: Inches *EHS: *Chain: J J Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve El Yes El No Approyal Status PVC unions ❑ Yes ElNo ❑ iApproved D DlsPPa roved ; ; Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes 0 No e CDP File Number 197812 - 1 County ID Number: Electric Equipment NEMA4XBox or Equivalent ❑ Yes ❑ NO Installer. Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Box Pump Tank ❑ Yes ❑ NO Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: / Approval Status Alarm Audible ❑ Yes O No p Approved❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140-Na' s,Robert 'Operation Permit completed by: Authorized State Agent: Date of Issue: 0 8 / 1 7 / 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 by a TYPE I k sewage septic system. Rule.1961 requires that a Type TYPE II A septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Mirnimum System InspectioNMaintenance 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 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 public or private management entity, unless the system ownerand 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. 4 Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 197812- 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: I I Olnch Drawing DrawO Drawing Type: Operation Permit Scale: ONAck ft. � I i 1 I CONSTRUCTION For office use only AUTHORIZATION *CDP File Number 197812-1 Davie County Health Department County ID Number. 210 Hospital Street ' p 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 0 Applicant: Collins Home Builders, Inc Property Owner: Drew Ridenhour Address: 971 Markland Road Address: Ridge Road CRY: Advance City: Mocksville StatelZip: NC 27006 StatefZip: NC 27028 Phone#: (336)345-3992 Phone#: (336)909-1416 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Ridge Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY 1-40 west exit Hwy 64 Left on 64, right on Greenhill Rd, right Davie academy turns into Ridge Road lot is on the #of Bedrooms: 4 left #of People: Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign ssification: Provisionally suitable Inches Minimum Soil Cover. System? *Yes ONo 1 a Inches low: 4 $ 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a Maximum Soil Cover: a 4 Inches *System Classification/Description: "Distribution Type: GRAVITY-SERIAL TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 _ Gallons *Proposed System: 25%REDUCTION 1-Piece: Oyes ®No Pump Required: OYes @No O May Be Required Nitrification Field a 4 0 0 Sq.ft. Pump Tank: Gallons No.Drain Lines 5 i-Piece: OYes ONo Total Trench Length: 6 0 0 ft GPM vs— ft. TDH Trench Spacing: Inches O.C. — 9 . @Feet O.C. Dosing Volume: 0 _ Gallons Trench Width: Inches 3 _ 2Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01011 0111 01V Donn 4 of Q CDP File Number 197812 - 1 County ID Number. ❑ Open Pump System Sheet '\ Repair System Required:@Yes ONo ONo, but has Available Space epair System Trench Spacing: 9 E,3� lnches 0.*Site Classification: Provisionally Suitable — Feet O.C. Trench Width: Inches Design Flow: 2 4 0 0 — . 3 . 2 Feet Soil Application Rate: 0 Aggregate Depth: inches Minimum Trench Depth: a 4 "System Classification/Description: Inches TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. 1 a Inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Nitrification Field a 4 0 0 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 5 "Distribution Type: GRAVITY-SERIAL Total Trench Length: 6 � � ft Pump Required: OYes @N.o 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 Penult,not to exceed five years,and may be issued atthe'same time the Improvement Permit issued(NCGS 130A-336(b)�If theinstallation 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 orConstruction Authorization shall become Invalid,and may be suspended or revoked(.1937(8)).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 j1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps.Signature: Date:. 2140-Nations,Robert 1 0 / .2 5 / .2 0 1 5 'Issued By: Date of Issue: ._ - - • 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 P.O.Box 848 County File Number. Mocksville NC 27028 Date: 1 0 / .1 5 / 2 0 1 5 Q Inch Drawing Drawing Type: Construction Authorization Scale: . ON A k ft. I Ad 57 fi Cr o CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: P.O.Box 848 Mocksviile NC 27028 County File Number: Date: .1 Click below to import an Image from an external location: Drawing Type:Construction Authorization . IMPROVEMENT PERMIT For Office Use only *CDP File Number 197812-1 r � Davie County Health Department 210 Hospital Street County ID Number. P.O.Box 848 Evaluated For. NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 10/25!2020 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Collins Home Builders, Inc Property Owner. Drew Ridenhour Address: 971 Markland Road Address: Ridge Road City: Advance City: Mocksville State/Zip: NC 27006 StatefZip: NC 27028 Phone#: (336)345-3992 Phone#: (336)909-1416 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Ridge Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY 1-40 west exit Hwy 64 Left on 64, right on Greenhill #of Bedrooms: 4 Rd, right Davie academy turns into Ridge Road lot is #of People: On the left "Water Supply: PUBLIC System Specifications nitiaTl S stem *Siteas(:I sification:Provisionally Suitable Minimum Trench Depth: a 4 Inches Seprolite System? (: Yes ONo Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 . a 1-piece: OYes ®No Pump Required: OYes @No OMay Be Required *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 25%REDUCTION 1-Piece: OYes ONo Repair System Required:OYes ONo ONo, but has Available Space Repair System *Site'Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inches Soil Application Rate: a Maximum Trench Depth: 3 6 CInches * Pump Required: OYes Q No O May be Required System Classification/Description: - - TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 197812" 1 County ID Number: *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 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: ; Site OPlan The Improvement Permit shall be valid for 5 years from date of Issue with a site pian(means a drawing not,necessarily drawn to C scale that shows the existing and proposed property lines with dimensions,the location of thefadlity and ppurtenances,the site forthe 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 O surveyor,drawn to a scale of one inch equals no morethan 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-335th).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(1838(b)) Applicant/Legal Reps.Signature Required? Oyes ONO Applicant/Legal Reps.Signature', Date: "Issued By: 2140-Nations,Robert Date of Issue: 1 0 / 2 5 / a 0 1 5 OValid without Expiration? Authorized State Agent: 0Create CA? (R)Hand Drawing OlmportDrawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 197812 - 1 • Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: L—L/ / Qlnch Drawing Drawing Type: Improvement Permit Scale: . OBlock QN/A r IL S eob -Q I ; y 4 i 1 � IMPROVEMENT PERMIT Davie County Health Department 210 Hospital street CDP File Number: 197812 - 1 P.O.sox 848 Mocksvi0e NC 27028 County File Number: Date: l e l a s 1 2 0 1 5 Click below to import an Image from an external location:Drawing Type: Improvement Permit APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC f— Mocksville, pAID Davie County Environmental Health Date;P.O.Boa 848/210 Hospital StreetNC 27028 QM (336)753-6780/Fax(336)753-1680 Application For. H Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) ❑Both Type of Application: Aew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility sssIMPORTANT"*THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Bille rr, AL u2TSt ontact Person Billing Address 411 I ' Home Phone City/State/ZIP ¢, V Business Phone„ Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION 'Date House/Facility Comer;Flagged 1.6 1124ibi NOTE: A survey plat or site plan must accompany this application. Included:Wd ite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Namer Phone Number 31C C1 114l(o Owner's Address City/State/Zip Property Address City-M&k_ UALO Lot Size U 0 Tax PIN# 0:3 09 Subdivision Name(if applicable) Section/Lot# Directions To Site: A V! { - Z If the answer to any of the following que tions is`ryes",supporting documen ion must be attached. Are there any existing wastewater systems on the site? ❑Yes 6]'llo Does the site contain jurisdictional wetlands? ❑Yes I-foo Are there any easements or right-of-ways on the site? ❑Yes aRo Is the site subject to approval by another public agency? ❑Yes Bl% Will wastewater other than domestic sewage be generated? ❑Yes KNo IF RESIDENCE FILL OUT THE BOX BELOW #People _L #Bedrooms to #Bathrooms 2.9 Garden Tub/Whirlpool❑Yes Ao Basement:l3Yes ❑No Basement Plumbing: ElYes ❑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: #Seats Type system requested: ltonventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type:le&unty/City Water ❑New Well ❑Existing Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intin_d'ed serve eyes ❑No • Ifyes,what type? 54'rM-�K,�- (Y1o�, + L'�.u�.Tl l � - �L � � �6--p 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 a es. Inders d that I am responsible for the proper identification and labeling of property lines and corners and locati g flag i king the house/facility location,proposed well location and the location of any other amenities. Prop rty owner s or owner's legal representative signature Site Revisit Charge Date(s): 0 (p Client Notification Date: Date EHS: Sign given ❑Yes❑No Account# Revised 11/06 Invoice# ��006,635ik6�� °� ,.B4 CLJV1 1.,dADl I.],iu91 u9,Qt91 .11b Gel Ib1dl!DI 1 :+:aI 100 0 x.00 200 30C In}arms L.. ! 7� GRAPHIC SCALE, — FEET 10+cml 3wml ,c,o-sa ,:^rail "'C\ lz:ill 125am 10,Wm1 N PK „I._ lle,alml nl,m,da 11,liarml 119ACi.: 1 Its fr,Ccl 1" q n91cc] —7M /90,111 101,161 ,oe,nl Ice♦nl ,'UY� ^ter r`.'�S t^" "}q. I '.^"'R F VI 7657 �41 �' Y it '•_ V'/� fit,• t � / J �•f� �,� y , tr t : ar ✓ .:"�% t r^;-. n�a.` �J .�t ��. ti y , .. AA '�ttitiwaua..��.. r 1 7 3 leil -77 ./.Jl� 88 1. 14•, a ^..•r�.y ..ti--.'7"f- ^•-.,...-..�X ,.,..,.y '1 , S. 571 .._dc...l_�w....,�..a..s+sv_._a�ts.�.v.i6,aua_'...X...� ...... -v.�'a 1ri�.:1,. ..N ,.. .x....._1 ... ._... _.a.�...,..r...x ..,+....... ��...... • e..,y.. n , .�.. .. +.. a.... ..a. ...�+. .,... :,__� .... ... .a. ..�.a _ . .r...,....r..t_ .>.+. .15cu'...�'.� Wraftmad All data is provided as is without warranty or guarantee of any n including but not limited to the Implied ®rn, ��V (JE warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of ! Davie,North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to or arising out of Printed:Oet 12 2015 S the use or inability to use the GIS data provided by this website. , i I