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127 Norma Lane Lot 16
t J • OPERATION PERMIT Davie County Health Department ¢ 210 Hospital Street Y. Spacing: STrenchinches P.O. Box 848 Mocksville NC 27028 Feet O.C. Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Sanford and Donna Jones Address: 127 Norma Lane City: Advance State/Zip: NC 27006 Phone #: Pro Address/Road,"": 127 Norma Lane Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 'Water Supply: NIA 'CDP File Number 121304-1 C7-100-AO.016 County ID Number: Evaluated For: EXISTING �ownship: Property owner: Sanford and Donna Jones Address: 127 Norma Lane City: Advance State/Zip: NC 27006 Phone #: erty Location & Site Information Subdivision: Woodlee Phase: Lot: 16 Directions 140 to 801, tum left going north. Woodlle Development 'IP Issued by. 2244 - Daywalt, Andrew 'System Classification/Description: TYPE IIA. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) 'CA issued by: 2244 - Daywalt, Andrew Saprolite System? QYes QNo Design Flow: 3 6 0 'Distribution Type: GRAVITY -SERIAL Pump Required? QYes QNo Soil Application Rate: 0 . 3 'Pre -Treatment: NIA Drain field Nitrification Field Sq. ft. No. Drain Lines Total Trench Length: 2 6 4 n• Spacing: STrenchinches O.C. — Feet O.C. Inches Trench Width: — OFeet Aggregate Depth: inches Minimum Trench Depth: Inches Minimum Soil Cover. Inches Maximum Trench Depth: Inches Maximum Soil Cover: Inches 'System Type: INFILTRATOR QUICK 4 STANDARD Installer: randy miller and son Certification #: 'EH S: 2244 - Daywalt, Andrew Date: 0 5/ 3 1/ 2 0 1 3 Approval Status El Approved 0 Disapproved CDP File Number 121304-1 Manufacturer existing STB: Gallons: Date: / / 'Filter Brand: ST Marker: ❑ Yes ❑ No nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Manufacturer. PT: Gallons: Countv ID Number: C7-IMAo-016 Lat. Long: Installer: Certification #: 'EHS: 2244 - DaywalL Andrew Date: Approval Status El Approved ❑ Disapproved Pump Tank Date: / / Riser Sealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) einforced Tank: ❑ Yes ❑ No `l Piece Tank: ❑ Yes O No Pipe Size: inch diameter Pipe Length: feet 'Schedule: Pressure Rated ❑ Yes ❑ No approved fittings ❑ Yes ❑ No Installer: Certification #: 'EHS: Date: Approval Status ❑ Approved ❑ Disapproved Supply Line Installer: Certification #: 'EHS: 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 0 No CDP'File Number 121304 - 1 NEMA 4X Box or Equivalent Box 12 inches Above Grade Box Adj. To Pump Tank Conduit Sealed Pump Manually Operable 'Activation Method: Approval Status Alarm Audible El Yes ElNo ❑ Approved ❑ Disapproved Alarm Visible ❑ Yes ❑ No 2244 - Daywalt, Andrew 'Operation Permit completed by: 01 Asa Authorized State Agent: Date of Issue: 0 5/ 3 1/ 2 0 1 3 This system has been installed in compliance wth 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 Il A. sewage septic system. Rule .1961 requires that a Type TYPE II A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora homelbusiness 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 homelbusiness 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 priorto the issuance of an Operation Permit for a system required to be maintained bya 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 Olmport Drawing **Site Plan/drawing attached.** Activity Code: S-23C-O/P ISSUED -REPAIR 11 Total Time:(1-IH-10,I) 0 2 Hours 0 0 Minutes Electric Equipment County ID Number: C7 -100 -At) -016 ❑ Yes ❑ No Installer: ❑ Yes ❑ No Certification 9: ❑ Yes ❑ N o ❑ Yes ❑ No 'EHS: ❑ Yes ❑ No Date: Approval Status Alarm Audible El Yes ElNo ❑ Approved ❑ Disapproved Alarm Visible ❑ Yes ❑ No 2244 - Daywalt, Andrew 'Operation Permit completed by: 01 Asa Authorized State Agent: Date of Issue: 0 5/ 3 1/ 2 0 1 3 This system has been installed in compliance wth 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 Il A. sewage septic system. Rule .1961 requires that a Type TYPE II A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora homelbusiness 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 homelbusiness 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 priorto the issuance of an Operation Permit for a system required to be maintained bya 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 Olmport Drawing **Site Plan/drawing attached.** Activity Code: S-23C-O/P ISSUED -REPAIR 11 Total Time:(1-IH-10,I) 0 2 Hours 0 0 Minutes OPERATION PERMIT Davie County Health Department CDP File Number: 121304 -1 210 Hospital Street 210Box Bas County File Number: C7 -100 -AO -016 ' CONSTRUCTION AUTHORIZATION Davie County Health Department 4� 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Sanford and Donna Jones Address: 127 Norma Lane City: Advance State/Zip: NC 27006 Phone #: Address/Road #: 127 Norma Lane Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 'Water Supply: wA Subdivision: Woodlee / For Office Use Only "CDP File Number 121304-1 County ID Number: C7 -100 -AO -016 Evaluated For: EXISTING Township: PERMIT VALID UNTIL: 0 4/ a 9/ a 0 1 8 Property Owner: Sanford and Donna Jones Address: 127 Norma Lane City: Advance StatelZip: NC 27006 Phone #: Phase: Lot: 16 Directions 1-40 to 801, turn left going north. Woodlle Development System Specifications Page 1 of 3 Minimum Trench Depth: a 4 Site Classification: PS - Inches Minimum Soil Cover. Sap rolite System? QYes G)No Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - 3 Maximum Soil Cover: Inches 'System Classification/Description: 'Distribution Type: GRAVITY - SERIAL TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Gallons 'Proposed System: 25% REDUCTION 1 -Piece: QYes ONo Pump Required: QYes QNo OMay Be Required Nitrification Field Sq ft Pump Tank: Gallons No. Drain Lines 1 -Piece: QYes QNo Total Trench Length: 3 0 0 GP10—vs— ft. TDH ft Trench Spacing:_ 9 Inches O.C. Dosing Volume: _ Gallons 8 g Q Feet O.C. Trench Width: 3 6 Inches 8Feet — Grease Trap: Gallons Aggregate Depth: - - - inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: OI Oil OIII OIV Page 1 of 3 CDF 'File Number .121304-1 County ID Number: C7 -100 -AO -016 ❑ Open Pump System Sheet Repair System Required:OYes ONo ONo, but has Available Space *Site Classification: Design Flow: Soil Application Rate: *System Classification/Description: 'Proposed System: Nitrification Field Sq. ft. No. Drain Lines Total Trench Length: ft. Trench Spacing: — Q Inches 0. ()Feet O.C. Trench Width: Inches Feet Aggregate Depth: inches Minimum Trench Depth: Inches Minimum Soil Cover. Inches Maximum Trench Depth: Inches Maximum Soil Cover: Inches *Distribution Type: 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. '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 Penni; not to exceed five years, and maybe 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? Oyes ONo Applicant/Legal Reps. Signature* Date: / *Issued By: 2244 - Daywall. Andrew / Date of Issue: 0 4 / a 9 / 2 0 1 3 Authorized State Agent:P[/i ,it,t�tA)1 4- Malfunction Log ()Yes 01 -land Cffawing Olmport Drawing Total Time:(HHJJ1.l) **Site Plan/Drawing attached.** 0 1 Hours 0 0 Minutes Page 2 of 3 S-10 - CIA ISSUED - REPAIR CONSTRUCTION AUTHORIZATION y Davie County Health Department CDP File Number: 121304 -1 210 H'tai Str t osp� ee C7 -100 -AO -016 P.O. Box 848 County File Number: Mocksville NC 27028 Date: ©4 / 2 9/ 2 0 1 3 Olnch Drawing Drawing Type: Construction Authorization Scale: , OBlock ON/A DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Lnproret`nents Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR I, DATE ;%' n?' . n1 S—PERMIT LOCATION N° '723 J/ � .! ; �,...;,, % �.;:e {� • S.R. NO. SUBDIVISION NAME �,. �/,, ,,�`J % r.;� LOT NO. �,SECTION OR BLOCK NO. HOUSE I] MOBILE HOME BUSINESS ❑ NO. BEDROOMS NO. BATHROOMS 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO 0 AUTO. DISHWASHER YES NO ❑ AUTO. WASH. MACHINE YES [3 --'NO ❑ SITE SUITABLE YES [3. --NO ❑ SIZE OF TANK 1,7)r-) gal. NITRIFICATION FIELD ff' sq./ t.`� ' DEPTH OF STONE IN LINES: -?,rJ WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY CERTIFICATE OF COMPLETION BY—� �- House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. X900SqI. Ftt�:`} 1000 Gal. 1 00-"$q:`Tt. INSTALLED BY (8/16/73) *Construction must compt�,,taith all other app LOT AREA //.:% ;• /t� �e i a Date le State and loca regulations` r AIT —taisal Card, DAVIE COUNTY. NC Page 1 of 1 A /10 /7111 i R-ASei(. AM ONES SANFORD R JONES DONNA H Return/Appeal Notes: C7 -100 -AO -016 127 NORMA LN UNIQ ID 2470 1514000 DI18-P24 - ID NO: 5862681932 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 LOT 16 WOODLEE SECTION THREE 1.000 LT SRC- Inspection Appraised by 19 on 05/01/2008 03301 CREEKWOOD ESTATES TW -03 C- EX- AT- LAST ACTION 20110712 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3FOBS Funtlonal 0.1500 ontinuous Footing5.0 Eff. BASE Obsolescence ub Floor System - 4 Standard 0.3300 PI wood 8.0 USE MO Area UA RATE RCN EYB AVBCREDENCE TO MARKET xterior Walls - 08 asonite on Sheathing 31.0 01 Ol 1 901 129 90.3017436 198 197 % GOOO 1 52.0 DEPR. BUILDING VALUE - CARD 90,67 xterior Walls - 21 ace Brick 0.0 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE - CARD MARKET LAND VALUE - CARD 30,00 oofing Structure - 03 able 8.00P STORIES: 8 - Split Foyer y TOTAL MARKET VALUE - CARD 120,67 oofing Cover - 03 OTAL APPRAISED VALUE - CARD 120,67 TOTAL APPRAISED VALUE -PARCEL 120,67 s halt or Composition Shingle - 3.0- - nterior Wall Construction - 4 Iood Panel 18.00 nterior Wall Construction - 5 )rywall/Sheetrock 0.0 TOTAL PRESENT USE VALUE - PARCEL nteriOr Floor Cover - 08 heet Vln I/Laminate 6.0 +- - - - 2 4 - - - - - + - - - - 24----+ TOTAL VALUE DEFERRED - PARCEL OTAL TAXABLE VALUE - PARCEL 120,67 nterlor Floor Cover - 14 .arpet 0.0 1FBM IBUG I I I I eating Fuel - 04 PRIOR BUILDING VALUE 94,07 BXF VALUE ledric 1.0 I 1 I I I I 2 2 2 eating Type - 04 orced Air - Ducted 4.00 8 8 8 1 1 I LAND VALUE 30,00 PRESENT USE VALUE Ir Conditioning Type - 03 entral q,O I I I I 1 1 DEFERRED VALUE OTAL VALUE 124 07 Brooms/Bathrooms/Half-Bathrooms 3/2/0 12.00 I I +-'--24"---+'---24-'--+ Brooms AS-3FUS -0LL-O throoms PERMIT AS-2FUS -0LL-O +- 30-+ 1 W D D 1 0 0 CODE DATE NOTE I NUMBER F AMOUNT ffice +---18---+-10-+---20---+ I B A S I I I I - I I I 2 2 8 6 I I ROUT: WTRSHD: TOTAL POINT VALUE 1100.00C BUILDING ADJUSTMENTS SALES DATA Quality4 ABAVG 1.200 FF' RECORD ATE DEED ITYPE INDICATE SALES PRICE ha a Desi 4 FACTOR 4 1.050 BOO AGE R Size 131 Size I 1.020C 0128 248 1 190 WD U I 5700 TOTAL ADJUSTMENT FACTOR 1.29 TOTAL QUALITY INDEX 129 1 1 I I I 2 + - - - - - - - - - - 48 - - - - - - - - - - + HEATED AREA 2,016 4FOP 4 NOTES +---------- 48----------+ SUBAREA UNIT ORIG % ANN DEP % OS/XF DEPR. TYPE GS AREA % RPL CS ODE DESCRIPTION LTH H NIT PRICE GOND BLDG#L B Ay" EYB RATE V COND VALUE AS 1 34 30 12136 10 ON PAVING 4 1 48 4.0 10 L 197 197 S1 1 01 BUG 67j 02 15170 UE BM 67 04 27271 OP 192 03 605 DD 100 02N 180 3 - 1 Story FIREPLACE 2,70 Sin le 174,36ILDING DIMENSIONS BAS-W20WDD=NIOWIOS10EI0 W28S28FOP=S4E48N4W48$E48N28 PTR=N20 BUG=N28W24 FBM=W24528E24N28$S28E24 520 . NO INFORMATION [UBAREATALS2.98 GNEST THER ADJUSTMENTS TOTAL D BEST USE LOCAL FRON DEPTH / LND COND ND NOTES OA LAND UNIT LAND UNIT TOTAL ADJUSTED LAND LAND E CODE ZONING TAGE DEPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES R RES 0100 112 160 1.0000 0 1.0000 PW 30 000.0 1.00 LT 1.00 30 000.0 3000TAL MARKET LAND DATA 30,00 OTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=C7100A0016 4/29/2013 DAVIE COUNTY HEALTH DEPARTMENT (Septic', Tank) Improvements Permit and Certificate of Completion (Ground. Absorpqon Sewage Disposal ;System - G. S: Chapter=130; Article 13C) AXE - OR CONTRACTOR,, ;( of �. ; li'rf r4" + {'.ice �; DATE -• . 7S— PERMIT f 3 . � 1•i � .: ,, � 1 � ri JLOCATION t, a�,,. 1 tP� �t�^"."7 ` , .�; i. +44, G -.E ' x� .. r ' ,•. � 0 1833 . ;, .+ . Wr.s s t a 1\ . . SUBDIVISION,NAME' LOT N0. SECTION OR BLOCK NO. HOUSE MOBILE HOME BUSINESS ❑ a, NO. BEDROOMS .. ;1 NO. ..BATHROOMS House Trailer:... 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 $q. Ft.. GARBAGE DISPOSAL UNIT YES• ❑ NO E3 ' Three Bedroom House 900 Gal. 900 .Sq. Ft. . AUTO. DISHWASHER''" ' -YES N0 ❑ Four :Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE .. YES'' NO - ' ❑ SITE SUITABLE - YES '❑ NO ❑ 41 *h, /I aa �� SIZE OF . TANK ga.l... a {. NITRIFICATION FIELD'-. sq. ft.'; 1` DEPTH OF STONE INLINES:. ° % r r 7f r`/iit eff WATER SUPPLY: Individual ❑ P, blIic ❑ IMPROVEMENTS PERMIT BYi' 75:4-J INSTALLED BY CERTIFICATE .OF COMPLETION i, C� BY Date (8/16/73) *Constructiotn'must,comply with all other applicable State and•local egulations LOT AREA i ,'j- A .r T DAV I E COUNTY HEALTH DEPARTMENT P. 0. BOX 57 IOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME � i&�-, DATE ISSUED `)/S` 7_-p ADDRESS PERP-fIT N0. 3,` Explanation of charge % c� r AMOUNT DUE )6 SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.