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187 Sonora Drive' CONSTRUCTION Minimum Trench Depth: a 4 Inches For Office Use only AUTHORIZATION Saprolite System? OYes GNo "CDP File Number 218816-1 Minimum Soil Cover. 1 a Inches Davie County Health Department County ID Number: ` 210 Hospital Street Maximum Soil Cover: a 4 Inches Evaluated For. NEW P.O. Box 848 TYPE 11 A- CONY SYSTEM (SINGLE-FAMILY -IT- ownship: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 7/ 1 a/ a 0 a 1 Applicant: Robert M Frazier Property Owner: Robert M Frazier Address: 187 Sonora Drive Address: 187 Sonora Drive CRY: Advance City: Advance StatefLip: NC 27006 State/Zip: NC 27006 Phone #: (336) 350-3145 Phone #: (336) 350-3145 Address/Road #: Granada Drive Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 2 # of People: 'Water Supply: PUBLIC Subdivision: LaQuinta/Woodvalley Phase: Lot: Directions Hwy 64 East, left on Cornatzer Rd. left on Beauchamp Road, left into LaQuinta. left on Sonora, right Granada system specifications Dann 9 of Z Minimum Trench Depth: a 4 Inches Site Classification: Provisionally suitable Saprolite System? OYes GNo Minimum Soil Cover. 1 a Inches Design Flow: a 4 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: TYPE 11 A- CONY 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 OMay Be Required Nitrification Field 8 7 3 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1 -Piece: OYes ONo Total Trench Length: a 1 8 ft GPM—vs— ft. TDH Trench Spacing:g _ 9 Inches O.C. Dosing Volume: _ Gallons Feet O.C. Trench Width:_ 3 Q Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 OI I 0111 01V Dann 9 of Z CDP File Number 218816 - 1 County ID Number: ❑ Open Pump System Sheet Repair system Kequired:vTes k_,) 1,40 vlvv, put nas Hvanaule opace *Site Modifications No grading or construction activityis allowed in areas designated forsystem and repairwithout 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. 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 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 maybe 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: 0 7/ 1 a/ a 0 1 6 Authorized State Agent: Malfunction Log OYes CX @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 Trench Spacing: 9Inches O. #Feet *Site Classification: Provisionally Suitable — O.C. Design Flow: Trench Width: 0 Inches 3 Feet a 4 0 _ Aggregate Depth: Soil Application Rate: 0 a 7 5 inches "- Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS,' Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 *Proposed System: 25% REDUCTION Inches Maximum Soil Cover: a 4 Nitrification Field 8 7 3 Inches Sq. ft. No. Drain Lines 3 *Distribution Type: GRAVITY -SERIAL Total Trench Length: a 1 8 Pump Required: OYes ONo OMay Be Required �. Pre Treatment: ONSF OTS -1 OTS -11 , *Site Modifications No grading or construction activityis allowed in areas designated forsystem and repairwithout 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. 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 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 maybe 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: 0 7/ 1 a/ a 0 1 6 Authorized State Agent: Malfunction Log OYes CX @Hand Drawing Olmport 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: 218816 -1 County File Number: Date: 07 / 12/.2016 Q Inch Scale: . QBlock QN/A L! I I I L ........ .. I I l I I �i ! I _�► T l _..._►_ 1 CA I� 111111 l I � � � i I I � I- 1 ��• � 1�� I I t � E T i E .._....�...i.«..«....„..,'.._.. .»�,.. ..._...�,.n.«. r..i ._ ;. ...'.... .....«».«.�_.. 1_......_.... �_ ! #.» .�...,._i.,.,.. I �...... ..._.i ._ � _ moi. i E l t CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box M Mocksviile NC 27028 CDP File Number: 218816 -1 County File Number: Date: .0 7/ 1 2/ 2 0 1 6 Click below to Import an image from an external location: Drawing Type: Construction Authorization IMPROVEMENT PERMIT :.� Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 r For Office Use Only *CDP Fite Number 218816-1 County ID Number: Evaluated For: NEW ..Township; Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID UNTIL 6/9/2021 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Robert M Frazier Address: 187 Sonora Drive CRY: Advance State/Zip: NC 27006 Phone #: (336) 350-3145 Address/Road #: Granada Drive Advance NC 27006 Structure:. -SINGLE FAMILY # of Bedrooms: 3 9 of People: *Water Supply: PUBLIC Property owner: Robert M Frazier Address: 187 Sonora Drive City: Advance State2ip: NC 27006 Phone #: (336) 350-3145 Subdivision: LaQuinta/Woodvalley Phase: Lot: Provisionally Suitable Saprolite System? OYes ( No Design Flow: 3 6 0 Soil Application Rate: 0 2 7 5 *System Class ii`cation/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Directions Hwy 64 East, left on Cornatzer Rd. left on Beauchamp Road, left into LaQuinta. left on Sonora, right Granada Minimum Trench Depth: 2 4 Inches Maximum Trench Depth: 3 6 Inches Septic Tank: 1 0 0 0 Gallons 1 -Piece: OYes @No Pump Required: OYes Q No O May Be Required Pump Tank: Gallons 1 -Piece: OYes ONo Repair System Required:(SYes ONo ONO, but has Available Space Repair System *Site Classification: Provisionally Suitable Soil Application Rate: 0 2 7 5 *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Minimum Trench Depth: 2 4 Inches Maximum Trench Depth: 3 6 Inches Pump Required: OYes ONo O Maybe Required Page 1 of 3 CDP File Number 218816 -1 *Site Modifications County ID Number: Q 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 ofthis permit bythe Health Department in no wayguarantees the issuance ofother permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for 5 years from date of issue with a site pian (means a drawing not necessarily drawn to .-scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the site for the 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 -335(i!). 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)j Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature; Date: / / "Issued By: 2140 - Nations, Robert Authorized State Agent: Date of Issue: 0 6/ 0 9/ 2 0 1 6 OValid without Expiration? 0Create CA? OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT ' Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Improvement Permit CDP File Number: 218816 - 1 County File Number: Date: Qlnch Scale: pBlock QN/A .............. I __L_ _+_17 i .. ...... ......... . ... ...... . ....... ........... .... . ...... . . ............1j1j --- - - ------- f i C_r 1 .. . ..... ..... : _I.w � i s I I 1 !t I 1 a ,7 . . . . . . . . . . - Y - - � � s ° - - - - - - - - - - - - I i ._ __ _------------ d - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ­--­- ---- - - --- ---- - 1 04' R CA to v I, f l k IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street CDP File Number: 218816 -1 P.O. Box 848 Mocksville NC 27028 County File Number: Date: 40 A 64/10 -4 9 J/ ©9 / 2 0 1 6 Click below to import an image from an external location: Drawing Type: Improvement Permit NCDENR Division; of Environmental Health On -Site Wastewater Section Soil/Site Evaluation For On -Site Wastewater System "Date: @ 6/@ S i a@ 1 6 "File #: 1 1 8 8 16 PIN #: 'Owner Robert M Frazier Proposed Facility SINGLE FAMILY Proposed Design Flow (.1949) 3 6 e Location of Site Granada Drive Property Size 1 Water Supply PUBLIC Evaluation Method Auger Profile# 1d940 Lan scape Slope % p Horizon Depth IN ) SOIL MORPHOLOGY .1941 Mineralogy Matrix Mottle Texture Structure Consistence Color Color Other Profile Factors 1 L G48 C 3-Stng sbk fi s p 7.5 YR Alp .1942 Wet. .1943 Depth GPS Saprolite:(in) .1943 Depth % GPS Saprolite: (in) .1944, Rest. Horizon 1947 Class EHS .1947 Class Rs EHS Profile LTAR @ • 2 7 5 Nations, Robe Profile LIAR Copy orile L G48 C 3-Stng sbk fi s p 7.5 YR ara .1942 Wet. % .1943 Depth GPS Saprolite:00 .1944 Rest. Horizon 1947 Class Ps ENS I LTProfileAR_L @ 7 5 Cop rorile Nations, Robe 3 L 048 C 3-Stng sbk fi s p 7.5 YR .1942 Wet. aiu 1 % .1943 Depth GPS Saprolite:(in) .1944 Rest. Horizon EHS .1947 Class ps Co r; rofile Nations, RobeLTgR @ 2 7 5 .1942 Wet. % .1943 Depth GPS Saprolite:(in) .1944 Rest. Horizon EHS .1947 Class Copy Profile Profile I El LTAR Available Space (.1945) S OtherFactors(.1946) Ste Classification (.1948)ps Initial LTAR: @ . ;1 7 5 Repair LTAR: @ . .1 7 5 Others Present: Comments: Evaluated By. Nations, Robert I % .1942 W et. .1943 Depth GPS Saprolite:(in) .1944 Rest. Horizon 1947 Class EHS Profile LIAR Copy orile Available Space (.1945) S OtherFactors(.1946) Ste Classification (.1948)ps Initial LTAR: @ . ;1 7 5 Repair LTAR: @ . .1 7 5 Others Present: Comments: Evaluated By. Nations, Robert I NCDENR ' Division of Environmental Health On -Site Wastewater Section date: Q s t e g a 6 Soil/Site Evaluation Fie #: 2188 16 For On -Site Wastewater System PIH #: Comments: 14940 Horizon SOIL MORPHOLOGY Profile# Lan scape Depth .1941 Other Profile Factors POS Sipe °�o (IN) Mineralogy Matrix Mottle Texture Structure Consistence Color Color or'o 1942 Wet, .1947 Class Profile LTAR .1943 Depth GAS SaprOfte:(in) Profile LTAR .1944 Rest. .1942 Wet, GPS COPY rofil Horizon ra.1947 .1943 Depth .1942 Wet, GPS copy-rofil U Class SHS copyfill .1944 Rest. Hofton ,1943 Depth .1947 Class EHS .1N4 Rest. rlZon Profile LTAR — • , Comments: 4'0 Saprolde:(in) .1942 +Net. GPS caEHS CopYErofil .1943 Depth .1944 ResL Horizon .1947 Class Profile LTAR EHS Profile LTAR % Saprolde:(in) .1942 Wet, GPS COPY rofil % Saprolite:fn) .1943 Depth .1942 Wet, GPS copy-rofil U .1944 Rest. Hofton ,1943 Depth .1947 Class EHS .1N4 Rest. rlZon Profile LTAR , •� Comments: oho Saprolite:(in) .1942 Wet. GPS Copy P Pro 0 .1943 Depth .1944_ Rest. Honzon ,1947 Class EHS Profile LTAR % Saprolite:fn) .1942 Wet, GPS copy-rofil U ,1943 Depth .1N4 Rest. rlZon .1947 Class EHS Profile LTAR Comments: • I I Attach Image The "Open Drawing Form" button, opens the the drawing form. The "Import" button, attaches the drawing, or other image into the space below. t Open Drawing Form Profile: 1 Q X Y Z Profile: 2 X Y Z Profile: 3 1@ X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z t APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street I! Mocksville, NC 27028 90tOt i (336)753-6780/ Fax (336)753-1680 a' R , Application For:Site Evaluation/lmprovement Permit E Authorization To Construct (ATC) ❑ Both Type of Application: ❑New System ❑ Repair to Existing System :3Expansion/Modification of Existing System or Facility *IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name Frra Lie% Contact Person Address r Home Phone City/State/ZIP Business Phone Email Email: Name on Permit/ATC if Different than Above Mailing Address City/State/Zip rKyrriKI T uvrvtUyiA t tyLV Tpate ttouseiractttty t:orners riaggea NOTE: A survey plat or site plan must accompany this application. Included: Li Site Plan LiPlat(to scale) (Permit is valid f r 60 months with site plan, no expiration with complete plat.) Owner's Name 6Wrnel Phone Number_ Owner's Address 4 City/State/Zip Property Addre s %= City. Lot Size I Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is "Yes",supporting docu a tion st be attached: Are there any existing wastewater systems on the site? lJlfes oleo Does the site contain jurisdictional wetlands? _Yes o Are there any easements or right-of-ways on the site? _Yes —oleo Is the site subject to approval by another public agency? _Yes Will wastewater other than domestic sewage be generated? Yes No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool I IYes o Basement: ❑Ye No Basement Plumbinz :]Yes abW 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: Conventional ❑Accepted ❑Innovative []Alternative ❑Other Water Supply TyplC�County/City Water ❑ New Well ❑Existing Well :1 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes ❑ No If yes, what type? This is to certify that t i rmation pr rde on this application is true and correct to the best of my knowledge. I understand that any permit T is ed herea r are ubject to suspension or revocation if the site is altered, the intended use changes, or if the inf ation b tte n this a icati is falsified or changed. I hereby grant right of entry to the Authorized Representative of t Davie C H t Dep me o conduct necessary inspections to determine compliance with applicable laws and rules. I rstan a a res the proper identification and labeling of property lines and comers and locating and flagging /faci i I cati n, proposed well location and the location of any other amenities. JV 0en 11 rty Site Revisit Charge own 's e s rept entativ signature Date(s): Client Notification Date: DaW I EHS: Sign given I Yes ❑No Account # Revised 11/06 Invoice # 322 �1 `136 4838 ;7859 'ff .... 3491 33 \ 1316 l.,, w ,t � 347 2806 h 0625 306 .� r'�`y.� fit' •--i ,F,.�',, 9485 8 r X307, f 1412 4348 X301 ;r \ j i 297 is f 287 -�Ft. / .52971,,e, 4159,' /17114 v ` J�7154 A\, j'7096 r,a ME1,1d 752 "258 1291 _ rl:LAQU�NTADR` .._ _......... , J; (i5 t ! t1Stl .. s 1�5 986 25� ....._MS � 168715 9766 60; l i $525, 9665 0, LIJ 87 9576rj , I�j25 „q, f 75 — 175 f 176 435 9V5 .. ty5 9386 m ' G , � �.... �... SAN MAR DR...........,... I o'w 059 91�i0 S 9 rbrt` All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Implied AV warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of of", Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to or arlsing out Printed: May 13, 2016 5 of the use or Inability to use the GIS data provided by this website. "Mm MAP ATA 4-O 01� / S ' (}* 08 197 pG FR'Z� RECORD REF[RF]iCEt A3a1/ O�j� C?pnLF DEED SM 197.PAOE No - MW NOON 129 PAGE 929 � _ / Q • ��� PUT e001T 4 PAGE 144-147 hl / 0.810 Acres± Power q0� /3� �• Proposed — >>, O /� \Home EPI — ��l�.\ /o�yti \ \ C-nt.-I — — — 1 1aNY CONPY RMT 1 N m Re O can a M[ ilei/ E7 ~� Awe aMm" Ie THAT iA01 i I WQ T w M[ N Or 8 10M Apo-Delm a R � \ /(�" EP q"• \ ` ) O RALPH h AIAREfA CROUSE �- aRt aeuwrr AMa 11NT 1 lo1Nr ANar as Laq v woNaoM iR1 W V VL rnlorE asTmlN ItLiAr tlana arwAlY loaf AAO mx'Aa \ S__� DB 673 PG 772 AIIJ:A iYAa. 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Iran - \ \ UP GRAPHIC SCAis ANN TIE TO MNS AT INTERSECTION I IN& . as PL LINE TABLE suavEr LINE LENGTH BEARING SCALE TOWNSHIP cawrtlr STATE DATE oAa111:oTLDAA.PLS EaR PHYLLIS SIMPSON Lll 30.54 S56.17.4VV I'.w slim -Rove Dwt N.e.: 5/27/16(`!/ I \v� 51,0r Lard 5u'� wq, Inc. _ SIIINETm tY"m OOMKMM ME* Joe Na - • MD BOON `fl Pnf ANW Lad 5AWW MA A POOmI Or A 700 Of yr0 AEmAOEn w "M soar 122 IMME 82L LI 38.00 S14'11'27'V OLD,. OLD SNPSW - 1940-14 7t1..- P4 51 ^1".'�ic3z0u`. n..irA)s 044 - PIN .5m2406t6---.. - - N Cl,T S S ,g11? 0( EPI N y o p& PARKER Nit, Y' ` '• pG 1 MANC � SS --• • /. 1MS-i4AT b SIMA1Sf TO ANY EASEIAiMIt. AWWDAMf4. aR IraMs--p-wAr oP wEWwO ihlaw TO twE OF 7M Till NOT NSM AT TW TME OF • ' �,Abt-3iaa * 7E12.7%' C' HAMILT $ ay. El P Do 1 OH 1,9 ,3B �B pG �75 41wTA - i 1w SUSJWT PROPEM 16 NOT WCATEO N A SPECIAL - nM HAZARD AREA AS OEIE>IW M BY WV FM MAP4- ,o _ _ _ S. NO TITh SEA" WM DOW AS: A PART OP IM tINTAM - / ' QC �' alW4Ly 111SSS 4. PROPUM OIM WMy N JW NNE ar We MOBEM R MYN fRA2ER, A NO OEODEIIC MOIRIIEIITAl10N FOLRO M71SN 2000 IFFY OF PROPERTY. -,` & ALL PROPEM GAVX LY mm RA.. NPS. / "Mm MAP ATA 4-O 01� / S ' (}* 08 197 pG FR'Z� RECORD REF[RF]iCEt A3a1/ O�j� C?pnLF DEED SM 197.PAOE No - MW NOON 129 PAGE 929 � _ / Q • ��� PUT e001T 4 PAGE 144-147 hl / 0.810 Acres± Power q0� /3� �• Proposed — >>, O /� \Home EPI — ��l�.\ /o�yti \ \ C-nt.-I — — — 1 1aNY CONPY RMT 1 N m Re O can a M[ ilei/ E7 ~� Awe aMm" Ie THAT iA01 i I WQ T w M[ N Or 8 10M Apo-Delm a R � \ /(�" EP q"• \ ` ) O RALPH h AIAREfA CROUSE �- aRt aeuwrr AMa 11NT 1 lo1Nr ANar as Laq v woNaoM iR1 W V VL rnlorE asTmlN ItLiAr tlana arwAlY loaf AAO mx'Aa \ S__� DB 673 PG 772 AIIJ:A iYAa. PA1gq AIw OMeI iNa Ali CANON" RT IM / I it 1UwR[ Ili q MO1D. \ \ \ 1 I RALPH do MAREIA CROUSE D8 673 PG 772 I EGEND \ A� Rte. DB 164 PG 303 ( ` 13' R' \ DT 277 PG 847 Md o (.IrRI MrwnM PIAN -er M+w Nra1 P0.NIP -NI Mw It. Iran - \ \ UP GRAPHIC SCAis ANN TIE TO MNS AT INTERSECTION I IN& . as PL LINE TABLE suavEr LINE LENGTH BEARING SCALE TOWNSHIP cawrtlr STATE DATE oAa111:oTLDAA.PLS EaR PHYLLIS SIMPSON Lll 30.54 S56.17.4VV I'.w slim -Rove Dwt N.e.: 5/27/16(`!/ I \v� 51,0r Lard 5u'� wq, Inc. _ SIIINETm tY"m OOMKMM ME* Joe Na - • MD BOON `fl Pnf ANW Lad 5AWW MA A POOmI Or A 700 Of yr0 AEmAOEn w "M soar 122 IMME 82L LI 38.00 S14'11'27'V OLD,. OLD SNPSW - 1940-14 7t1..- P4 51 ^1".'�ic3z0u`. n..irA)s 044 - PIN .5m2406t6---.. - - OPERATION PERMIT Davie County Health Department 210 Hospital Street pt ` P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Robert M Frazier Address: 187 Sonora Drive City: Advance State/Zip: NC 27006 Phone #: (336) 350-3145 Pro', Address/Road,"": _ Granada Drive Advance NC 27006 Structure:SINGLE FAMILY # of Bedrooms: 2 # of People: *Water Supply: PUBLIC *CDP File Number 218816-1 County ID Number. Evaluated For. NEW ` Township: �roperty owner: Robert M Frazier Address: 187 Sonora Drive City: Advance State/Zip: NC 27006 Phone #: (336) 350-3145 ierty Location & Site Information Subdivision: LaQuinta/Woodvalley Phase: Lot: Directions Hwy 64 East, left on Cornatzer Rd. left on Beauchamp Road, left into LaQuinta. left on Sonora, right Granada *IP Issued by. 2140 -Mations, Robert *System Classification/Description: TYPE 111 G. OTHER NON -CONN. TRENCH SYSTEMS *CA issued by: 2140- Nations, Robert SaproliteSystem? (Yes QNo Design Flow: GRAVITY -SERIAL Pump Required? a 4 0 *Distribution Type: QYes QNo Soil Application Rate: 0 - a 7 5 *pre Treatment: Drain field Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: 8 7 3 Sq. ft. 3 a18ft. 9 Inches O.C. Feet O.C. 3 Olnches Feet inches Minimum Trench Depth: 3 6 Minimum Soil Cover. a 4 Maximum Trench Depth: 3 6 1. Maximum Soil Cover: a 4 Inches *System Type: INFILTRATOR OUICK 4 STANDARD Installer: William Rueben Clayton III Certification #: 2694 *EH S: 2140 - Nations, Robert Date: 1 0/ a 4/ a 0 1 6 Inches Approval Status Inches ] Approved 0 Disapproved Inches CDP File Number 218816 -1 septic Manufacturer. Sho7af STB: 760 Gallons: 1000 Date: 0 7/ 3 1/ 2 0 1 6 *Filter Brand: POLYLOK PL -122 With Pipe Adapter ST Marker: ❑ Yes ® No Reinforced Tank: ❑ Yes El No Piece Tank: 11111,P ❑ Yes C] No Manufacturer. PT: Gallons: Countv ID Number: Lat. Long: Installer: William Rueben Ctayton 111 Certification 9: 2694 *EHS: 2140- Nations. Robert Date: 1 0/ 2 4 / 2 0 1 6 Approval Status C] Approved ❑ Disapproved Pump Tank Date: / / RiserSealed ❑ Yes ❑ No RiserHegtit: ❑ Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ No kpp roved fittings ❑ Yes ❑ No Installer: Certification #: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved upply Line Installer: Certification #: "ENS: 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 ❑ N 0 Approval Status - PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No \ Anti -siphon Hole ❑ Yes 0 No CDP File Number 218816 - 1 11=10,1IItoo 34tollUiii-1lt! County ID Number: NEMA4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj. To Pump Tank ❑ Yes ❑ N o Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Alarm Audible ❑ Yes Alarm Visible ❑ Yes *Operation Permit completed by. Authorized State Agent: Owner/Applicant Signature: ❑ NO Approval Status ❑ Approved ❑ Disapproved ❑ No 2140 • Nations, Robert Date of Issue: 1 0/.1 4 / 2 0 1 6 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 Ill G. sewage septic system. Rule .1961 requires that a Type TYPE III G. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: WA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: WA , 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 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 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. Hand Drawing Olmport 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 CDP File Number: 218816 -1 County File Number: Date: Olnch Scale: Oalock ON/A CONSTRUCTION AUTHORIZATION Davie County Health Department t _ 210 Hospital Street •q; a,• P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Robert M Frazier Address: 187 Sonora Drive City: Advance State/Zip: NC 27006 Phone #: (336) 350-3145 For Office Use Only *CDP File Number 218816 - 1 County ID Number: Evaluated For: NEW �, Township: IT VALID UNTIL: 0 7/ 1 a/ a 0 a 1 Property Owner: Robert M Frazier Address: 187 Sonora Drive City: Advance State/Zip: NC Phone #. (336) 350-3145 Property Location & Site Information 27006 Address/Road #: Subdivision: LaQuinta/Woodvalley Phase: Lot: Granada Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 East, left on Cornatzer Rd. left on Beauchamp Road, left into LaQuinta. left on Sonora, right Granada # of Bedrooms: 2 # of People: *Water Supply: PUBLIC Site Classification: Provisionally suitable Minimum Trench Depth: a 4 \ Inches Saprolite System? O Yes (9 No Minimum Soil Cover: 1 Inches Design Flow: a 4 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: 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: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field 8 7 3 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1 -Piece: OYes 0 N Total Trench Length: a 1 8 GPM --vs-- ft. TDH ft Trench Spacing: _ 9 O ® Inches O.C. Feet O.C. Dosing Volume: Gallons Trench Width: 3 O ® Inches Feet _ Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: O NSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01011 O III 01V / Page 1 of 3 CDP File Number 218816 - 1 Re *Site Classification: Provisionally Suitable County ID Number: ®Yes ONO ONO, but has Available Design Flow: --.2 4-0 Soil Application Rate: 0 a 7 5 *System Classification/Description: - TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Nitrification Field 8 7 3 Sq. ft. No. Drain Lines 3 Total Trench Length: .1 1 8 ft. Trench Spacing: Trench Width: ❑ Open Pump System Sheet ace 9 O Inches O. ® Feet O.C. 3 Inches Feet Aggregate Depth: inches Minimum Trench Depth: 01 4 Inches Minimum Soil Cover: 1 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches *Distribution Type: GRAVITY - SERIAL Pump Required: Oyes O No O May Be Required Pre -Treatment: O NSF 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. R..i� 9 750 *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. Ramal 9 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(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 (1938(b)). Applicant/Legal Reps. Signature Required? O Yes ONO Applicant/Legal Reps. Signature: *Issued By: 2140 - Nations, Robert Authorized State Agent: Date: Date of Issue: 0 7/ 1 2/.2 0 1 6 Malfunction Log Oyes ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 218816 - 1 P.O. Box 848 Mocksville NC 27028 County File Number: _ a Click below to import an in7ageroman external location: Drawing Type: Construction Authorizati { C `r Page 3 of 3 tD� Y ` P1 P2