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163 Valley Oaks Drive Lot 17f OPERATION PERMIT Davie County Health Department f To • a �`'�t s y 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Michael Herchenroder Address: 163 Valley Oaks Dr City: Advance State/Zip: NC 27006 Phone #: ro Address/Road #: 163 Valley Oaks Drive Advace NC 27006 Structure: SINGLE FAMILY # of Bedrooms: # of People: *Water Supply: N/A *CDP File Number 139809-1 County ID Number: Evaluated For: REPAIR Township: Property Owner: Michael Herchenroder Address: 163 Valley Oaks Dr City: Advance StatefZip: NC 27006 Phone #: N— lerty Location & Site I Subdivision: Valley Oaks *IP Issued by. *CA issued by: 2140 - Nations, Robert Design Flow: 3 6 0 Soil Application Rate: 0 - a 7 5 Phase: Lot: 17 Directions i-40 to Hwy 801 turn left then right on Yadkin Valley Rd. right in Valley Oaks *System Classification/Description: TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Saprolite System? OYes (DN o *Distribution Type: GRAVITY -SERIAL Pump Required? OYes ONo *Pre -Treatment: Drain field Nitrification Field 6 1 a Sq. ft. No. Drain Lines 3 Total Trench Length: a 0 4 ft. Trench Spacing: ()Inches O.C. — Feet O.C. Trench Width: 9 — ()Inches Feet Aggregate Depth: inches Minimum Trench Depth: 3 5 Inches Minimum Soil Cover. Inches Maximum Trench Depth: 3 7 Inches Maximum Soil Cover: Inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Joe Stafford Certification #: *EH S: 2325 - Mitchell, Brittany Date: 0 7/ 2 a / 2 0 1 4 Approval Status O Approved O Disapproved CDP File Number 139809 - 1 Manufacturer. i STB: Gallons: Septic Tank County ID Number: Lat. Date: Yes ❑ No RiserHeght: ❑ *Filter Brand: ❑ No (Min.6 in.) nforced Tank: ❑ Yes ST Marker: ❑ Yes ❑ No nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Manufacturer. PT: Gallons: Date: Long: Installer: Joe Stafford Certification #: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved Pump Tank RiserSealed ❑ Yes ❑ No RiserHeght: ❑ Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Su / Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ No Approved fittings ❑ Yes ❑ No Installer: Joe Stafford Certification #: *EHS: Date: / / Approval Status ❑ Approved ❑ Disapproved pply Line Installer: Joe Stafford Certification #: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved / Pump Type: Installer: Joe Stafford Dosing Volume: — Gal Certification #: Draw Down: Inches *EHS: *Chain: Date. Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ No Approval Status PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ No DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND, CERTIFICATE OF COMPLETION • II - *Note: Issued in Compliance with G.S. of North Carolina..Chapter 130—Article 13c. Permit Number Name rh„ l sr" Date % 2267 I Location %�° i`�, r %;r �' 1! I , d # r Subdivision Name_ '+ Lot No. . Sec. or Block No. .*Contact a represent 9:30 A.M.: or 1:00-1 ve;,of the Da�,ie County Health Department for final inspection of this system between 8:30- P.M, on day of completion. Telephone Number: 7047634-5985. Certificate' of Completion `�s ' t jt�t' ^ '" Date The signing of this.certificate shall Jndicate that the system described above has been installed in compliance with the standards set forth in,4he above 'regulation; bufshall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. CDP File Number 13"9809 -1 NEMA 4X Box or Equivalent ❑ Yes Box 12 inches Above Grade ❑ Yes Box Adj. To Pump Tank ❑ Yes Conduit Sealed ❑ Yes Pump Manually Operable ❑ Yes 'Activation Method: Electric Eaui ❑ No ❑ No ❑ No ❑ No ❑ No Alarm Audible ❑ Yes ❑ No Alarm Visible ❑ Yes ❑ No 2325 - Mitchell, Brittany 'Operation Permit completed by: Authorized State Agent: County ID Number: nt Installer. Joe Stafford Certification #: *EH S: Date: Approval Status ❑ Approved ❑ Disapproved Date of Issue: 0 7/ a a/.2 0 1 4 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 II A. 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 Minimum System Inspection/Maintenance 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 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. OHand Drawing OlmportDrawing **Site Plan/Drawing attached.** OPERATION PERMIT 139809-1 Davie County Health Department CDP File Number: • 210 Hospital Street P.O. Box 848 County File Number: Mocksville NC 27028 Date: 07/ x 2/ 2 0 1 4 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Michael Herchenroder Address: 163 Valley Oaks Dr CRY: Advance StatefZip: NC Phone #: r Address/Road #: 163 Valley Oaks Drive Advace NC 27006 Structure: SINGLE FAMILY # of Bedrooms: # of People: "Water Supply: N/A For Office Use Only *CDP File Number 139809-1 County ID Number: Evaluated For: REPAIR Township: PERMIT VALID UNTIL: 0 7/ 1 5/ 2 0 1 9 Property Owner: Michael Herchenroder Address: 163 Valley Oaks Dr City: Advance 27006 Statefzip: NC Phone #: Site Information Subdivision: Valley Oaks 27006 Phase: Lot: 17 Directions i-40 to Hwy 801 turn left then right on Yadkin Valley Rd. right in Valley Oaks ifications *Proposed System : 25% REDUCTION N krification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: a 0 0 ft, p Gallons 1 -Piece: OYes ONo Pump Required: OYes ONo OMay Be Required Sq. ft. Pump Tank: Gallons 1 -Piece: OYes ONo GPM—vs— ft. TDH 8Inches O.C. Feet O.C. Dosing Volume: Gallons _ gInches Feet Grease Trap: Gallons inches Pre -Treatment: ONSF OTS -I OTS -11 Septic Tank Installer Grade Level Required: 01 OII 0111 OIV Minimum Trench Depth: a 4 \ Site Classification: Provisionally Suitable Inches Minimum Soil Cover: 1 a Saprolite System? OYes OQ 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 II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Se tic Tank *Proposed System : 25% REDUCTION N krification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: a 0 0 ft, p Gallons 1 -Piece: OYes ONo Pump Required: OYes ONo OMay Be Required Sq. ft. Pump Tank: Gallons 1 -Piece: OYes ONo GPM—vs— ft. TDH 8Inches O.C. Feet O.C. Dosing Volume: Gallons _ gInches Feet Grease Trap: Gallons inches Pre -Treatment: ONSF OTS -I OTS -11 Septic Tank Installer Grade Level Required: 01 OII 0111 OIV CDP File Mumber 139809 - 1 County ID Number: ❑ Open Pump System Sheet Ir system Kequlrea:v r Csyrvv %-JIVV, UUt IIdb HVdI1dU!C JPdGC /Repair System Trench Spacing:8Feet Inches 0. *Site Classification: — O.C. Trench Width: S Inches Design Flow: _ Feet Aggregate Depth: Soil Application Rate: inches Minimum Trench Depth: *System Classification/Description: Inches Minimum Soil Cover. Inches Maximum Trench Depth: *Proposed System: Inches 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 -1 OTS -II "Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7; '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. 2( 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 maybe issued at the sametime the ImprovementPermit issued (NCGS 130A -336(b)). If the installation has not been completed during the period of validity of the Construction Perm it, 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? Oyes ONO Applicant/Legal Reps. Signature* Date "Issued By: 2140 - Nations, Robert Date of Issue: g 7 / 1 5 / a 0 1 4 Authorized State Agent: `�— Malfunction Log Oyes QHand Drawing Oimport Drawing **Site Plan/Drawing attached.** Pana 9 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 139809-1 210 Hospital Street P.O. Box 848 County File Number: Mocksville NG 27028 Date: 0 7/ 1 5/.;2.0,1.4 Olnch Drawing Drawing Type: Construction Authorization Scale: OBlo k 1 ° aA -/k_. n, I �b b DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name—v ,���1e«R� Date Location �sSd�f_`� — A0 . Subdivision Name Lot No. ( 1 Sec. or Block No. Lot Size _.. ,00-' 0 House Mobile Home — Business --- Speculation No. Bedrooms No. Baths zNo. in Family Garbage Disposal YES fl NO Specifications for System: �Ur�is t Auto Dish Washer YES M NO p Auto Wash Machine YES Ij NO p � 1�p q : Type Water Supply JO 'This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by `Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by _Donvi G L0tn('UqT+h SKS K0+ s&PI: rAe.Wjtd ci-z�(xi Certificate of Completion _ — Date "t " 2?– 71 "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APF DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name -- Date Location Subdivision Name Lot No Sec. or Block No. Lot Size House Mobile Home _ Business _— Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ ,. Auto Wash Machine YES ❑ NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. J Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by f !l 1 1 1 i Certificate of Completion Date "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. 1 1 1 11i 1 I i i .i } i J Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by f !l 1 1 1 i Certificate of Completion Date "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUllM. HEALTIi DEPAXIMENT PERCOLATION TEST RESULTS DATE h a NAME -1 LOCATION FINDINGS: °S'O/Y1O��l ell 2 3 4 5 _ 6 HOLE 140. COMMITS Z©n LOT DIAG'QAM 01 _�17) Q 65 3 By: