135 Chandler Drive Lot 37`
OPERATION PERMIT
.rst�
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: RS Parker Homes / Joy Springer
Address: PO Box 5967
City: High Point
State/Zip: NC 27262
Phone
Address/Road :
135 Chandler Dr
Mocksville NC 27028
Structure: SINGLE FAMILY
of Bedrooms: 4
of People:
*Water Supply: PUBLIC
*CDP File Number 136566-1
H519OA037
County ID Number.-
Evaluated
umber:Evaluated For: NEW
111T ownship:
Property Owner: RS Parker Homes / Joy Springer
Address: PO Box 5967
City: High Point
State/Zip: NC 27262
Phone:::
ierty Location & Site Information
Subdivision: McAllister Park Phase: Lot: 37
*IP Issued by:
*CA issued by: 2140 -Nations. Robert
Design Flow: 3 6 0
Soil Application Rate: 0 a 7 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
Minimum Trench Depth:
Nlinimum Soil Cover.
Maximum Trench Depth:
Maximum Soil Cover:
Directions
Hwy 158 to Sain Road turn Right then right into
Mcallister Park left on Chandler
*System Classification/Description:
TYPE III B. SYSTEM WISINGLE EFFLUENT PUMP
Saprolite System? OYes (_)No
*Distribution Type: PUMP TO GRAVITY Pump Required?
()Yes Otto
*Pre -Treatment:
Drain field
1 a 0 0 Sq. ft.
3 a 7 ft.
9 Qlnches O.C.
OFeet O.C.
Inches
3 Feet
inches
Inches
Inches
Inches
Inches
*System Type:
Installer: Frank Transou
Certification :::
*EH S: 2140 - Nations. Robert
Date: 0 6/ 3 0/ a 0 1 4
Approval Status
O Approved 0 Disapproved
CDP File Number 136566 - 1 County ID Number: H5190A037
Manufacturer. shoaf
STB:
760
❑
No
Gallons:
11000
1000
NO
Date:
Date:
0
a/
'Filter Brand:
a 0 1 4
Riser Sealed
❑
ST Marker:
❑ Yes
❑
No
Reinforced Tank:
❑ Yes
❑
No
\ 1 Piece Tank:
❑ Yes
❑
NO
I- —
Manufacturer. shoaf
nK
Lat.
Long:
Installer: tr-ansou
Certification:::
'EH S: 2140 - Nations, Robert
Date: 0 6/ 3 0/ a 0 1 4
Approval Status
❑ Approved ❑ Disapproved
Pump Tank
PT:
❑ Yes
❑
No
Flow Adjustment Valve
Gallons:
1000
NO
Check -valve
Date:
0
a/
a 3/
a 0 1 4
Riser Sealed
❑
Yes
❑
No
Riser Height:
❑
Yes
❑
No (Min.6 in.)
Reinforced Tank:
❑
Yes
❑
No
1 Piece Tank.
❑
YeS
❑
No
/ Pipe Size: inch diameter
Pipe Length: feet
Schedule:
Pressure Rated ❑ Yes ❑ NO
Approved fittings ❑ Yes ❑ No
Installer: transou
Certification r:
`EH S: 2140- Nations, Robert
Date: 0 6/ 3 0/.2 0 1 4
Approval Status
❑ Approved ❑ Disapproved
supply Line
Installer:
Certification
"EH S:
Date:
Approval Status
❑ Approved ❑ Disapproved
Pump Type: Installer:
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
CDP File Number. 136566 - 1
County ID Number: H5190A037
Alarm Audible ❑ Yes
Alarm Visible ❑ Yes
'Operation Permit completed by.
Authorized State Agent:
❑ No Approval Status
No ElApproved ❑ Disapproved
❑
2140 - Nations, Robert
Date of Issue: 0 6/ 3 0/ a 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 III B. sewage septic system.
Rule .1961 requires that a Type TYPE III B._ __ septic system meet the following criteria:
t0inimum System Review By The Local Health Department: 5YRS.
t.lanagement Entity: OWNER
1.tinimum System Inspectiowlvlaintenance Frequency By Certified Operator:
NIA
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a homer'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 horne.+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.
CPHand Drawing 0Import Drawing
**Site Plan/Drawing attached.**
crc�ur� �yurNnrcn�
r
NEMA 4X Box 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 10 anually Operable
❑
Yes
❑
No
'Activation Method:
Date:
Alarm Audible ❑ Yes
Alarm Visible ❑ Yes
'Operation Permit completed by.
Authorized State Agent:
❑ No Approval Status
No ElApproved ❑ Disapproved
❑
2140 - Nations, Robert
Date of Issue: 0 6/ 3 0/ a 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 III B. sewage septic system.
Rule .1961 requires that a Type TYPE III B._ __ septic system meet the following criteria:
t0inimum System Review By The Local Health Department: 5YRS.
t.lanagement Entity: OWNER
1.tinimum System Inspectiowlvlaintenance Frequency By Certified Operator:
NIA
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a homer'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 horne.+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.
CPHand Drawing 0Import Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Drawing Type: Operation Permit
`7 p
CDP File Number: 136566 - 1
County File Number: H5190A037
Date:
Olnch
Scale: Qalock = ft.
ON/A
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eNSWrv�
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: RS Parker Homes / Joy Springer
Address: PO Box 5967
City: High Point
State/Zip: NC 27262
Phone #:
Address/Road #:
135 Chandler Dr
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
*Water Supply: PUBLIC
Property Owner: RS Parker Homes / Joy Springer
Address: PO Box 5967
City: High Point
State/Zip: NC 27262
Phone #:
Subdivision: McAllister Park Phase: Lot: 37
'Directions
Hwy 158 to Sain Road turn Right then right into Mcallister
Park left on Chandler
Minimum Trench Depth: 4
Site Classification: Provisionally suitable Inches
SaproliteSystem? OYes
XNo
Minimum Soil Cover:
1 a 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:
PUMP To GRAVITY
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank:
1 0 0 0
Gallons
*Proposed System: 25% REDUCTION
1 -Piece:
O Yes ® No
Pump Required: (gYes
0 N O May Be Required
Nitrification Field
1
3
0
9 Sq. ft. Pump Tank:
1 0 0 0 Gallons
No. Drain Lines 4
1 -Piece:
OYes ®No_
Total Trench Length: 3
a
7
GPM --vs-- ft. TDH
ft
Trench Spacing:Olnches
_
9
O.C.
® Feet O.C. Dosing Volume:
_ Gallons
Trench Width:
3
Olnches
_
® Feet Grease Trap:
Gallons
Aggregate Depth:
inches
Pre -Treatment: O NSF OTS - I OTS -II
\
Septic Tank Installer Grade Level Required: 01011
O III ON /
Page 1 of 3
CDP •File Number 136566 - 1 County ID Number: H519OA037
❑ Open Pump System Sheet
Ulrecl: V T es V IVU v IVU, DUE rldti /1vdlldDle OPdUU
*Site Classification: Provisionally Suitable
Design Flow: ':Z A A
Soil Application Rate: 0 a 7 5
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
1 3 0 9 Sq. ft.
4
3 a 7 ft.
Trench Spacing:
9 O Inches O.
— ® Feet O.C.
Trench Width:3
O Inches
_ (9 Feet
Aggregate Depth:
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover:
1
a
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover:
a
4
Inches
*Distribution Type:
PUMP
TO GRAVITY
Pump Required: ®Yes 0 N OMay Be Required
Pre -Treatment: O NSF OTS -1 OTS -II
*Site Modifications
actm
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. R
750
*Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder
adm
is responsible for checking with appropriate governing bodies in meeting their requirements. R
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)). i
Applicant/Legal Reps. Signature Required? ®Yes ONO
Applicant/Legal Reps. Signature* Date: 0 3/ a 4/ a 0 1 4
*Issued By:
2140 - Nations, Robert Date of Issue: 0 3 a 4 a 0 1 4
Authorized State Agent: Malfunction Log OYes
9 Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Drawing Type: Construction Authorization
CDP File Number: 136566 - 1
County File Number: H519OA037
Date: 03 /a4/.2014
0Inch
Scale: 0 Block
0 N/A
Page 3 of 3
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CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 136566 - 1
County File Number: H519OA037
Date: .0.3./ . 4/ 2 0 14
Click below to import an image from an external location: Drawing Type: Construction Authorization
Page 3 of 3
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