298 Granada DriveI
OPERATION PERMIT
Davie County Health Department
t:
• 210 Hospital Street
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
rproperty Owner: Robert M Frazier
Address: 187 Sonora Drive
City: Advance
State2ip: NC
hone #: (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 Comatzer Rd. left on
Beauchamp Road, left into LaQuinta. left on Sonora,
of Bedrooms: 2 right Granada
# of People:
'Water Supply: PUBLIC
'IP Issued by. 2140 -Nations, Robert
'CA issued by: 2140 -Nations. Robert
Design Flow: -2 4 0
,Soil Application Rate: 0 a 7 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
"System Classification/Description:
TYPE III G. OTHER NON -CONY. TRENCH SYSTEMS
Saprolite System? QYes QNo
'Distribution Type: GRAVITY -SERIAL Pump Required?
QYes (E)No
'Pre Treatment:
Drain field
8 7 3 Sq. ft.
3
2 1 8 ft.
9 Inches O.C.
& Feet O.C.
Inches
3 s Feet
inches
'System Type: INFILTRATOR QUICK 4 STANDARD
Installer: William Rueben Clayton III
Certification #: 2694
"EH S: 2140 -Nations. Robert
Date. 1 0/ 2 4 / 2 0 1 6
CDP File Number 218816 -1
Manufacturer. Sho7af
STB:
760
Date:
Gallons:
1000
No
Date:
07/
3 1/
2 0 1 6
*Filter Brand:
POLYLOKPL•122 With Pipe Adapter
ST Marker.
❑ Yes
E
No
Reinforced Tank:
❑ Yes
C)
No
Irlece Tank:
El
(i]No
-
County ID Number:
311C TBnK
Pump Tank
Manufacturer. Installer.
PT:
Gallons:
Date: / 1
RiserSealed ❑ Yes ❑ No
Certification #:
*EHS:
Date:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings ❑ Yes ❑ No Approval Status
=n Aevr�rnvn'11—I tlic�nrsrnvci='
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 ElYes
❑
No
El,' Approved D Dlsapprovetl
Vent Hole ❑ Yes
❑
No
Anti -siphon Hole 0 Yes
❑
No
CDP File Number 218816 -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:
County ID Number:
Electric Eauloment
❑ No Installer:
❑ No Certification #:
❑ No
❑ No "EHS:
❑ No
Date:
Alarm Audible_ ❑ Yes ❑ No
Alarm Visible ❑ Yes ❑ No
2140 - Nations. Robert
`Operation Permit completed by:
Authorized State Agent:
. Owner/Applicant Signature:
Approval Status
Approved❑ Dlsapbroved'`
Date of Issue. 1 0/ x 4 / a 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 III G. sewage septic system.
Rule .1961 requires that a Type I TY'E III G• septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: N/A
Management Entity: OWNER
Minimum System InspectionMlaintenance Frequency ByCertified Operator.
N/A
_Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type 1V and V septic systems designed fora home/business owner must maintain a valid contract
- with a public management entitywkh 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 a public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements formaintenance 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 condilion 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: 21$$16 -1
County File Number:
Date: / I
Olnch
Scale: OBlock
ON/A
r
I
01
C)
I
{ " CONSTRUCTION
AUTHORIZATION
qY Davie County Health Department
" 210 Hospital Street
L P.O. Box 848
Mocksville . NC 27028
/ For Office Use Only
*CDP File Number 218816 - 1
County ID Number:
Evaluated For: NEW
Township:
-
Phone: 336-753-6780.Fax: 336-753-1680 0 7 / 1 a/ a 0 a 1
_ _Applicant: -Robert M Frazier
Address: 187 Sonora Drive
City: Advance
State/Zip: NC 27006
Phone #: (336) 350-3145
Property Owner: Robert M Frazier
Address: 187 Sonora Drive
City: Advance
State/Zip: NC 27006
Phone #: (336) 350-3145
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
item Specifications
"_
Site Classification:
Provisionally suitable
Minimum Trench Depth:
-
a 4
Inches
\
-- -
Saprolite System?
O Yes . l8 No
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 II A. CONY 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
ONo
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
R?Inches
Feet
—
Grease Trap:
Gallons
Aggregate Depth:
inches
Pre -Treatment: O NSF OTS -1 OTS -11
Septic Tank Installer Grade Level Required: 01011
O
111 01V /
Page 1 of 3
CDP File Number 218816 - 1
County ID Number:
- ❑ Open Pump System Sheet
Repair System Required: ®Yes ONO O No, but has Available Space
Repair System
Trench Spacing: 9 O
Inches O. .
Site Classification:_ .
Provisionally Suitable
— ®
Feet O.C.
Design
Trench Width:
3
Feet Inches
1
Flow:
a 4 0 ._
_
- -Aggregate
Depth:
Maximum Trench Depth:
3
Soil Application Rate:
0 .. oZ 5
inches
No. Drain Lines 3
'.'Tota Trench Length: a: 1 8 - 'ft Pump Required: OYes O No O May Be Required
- - Pre -Treatment: O NSF OTS -I OTS -II
*Site Modifications
No grading or. construction activity is allowed in areas designated -fors stem and repair without approval of Health Department. R 3
9 9 tY � 9Y P PP P
750
*Permit Conditions
The issuance of this permit by the Health Department in no guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. Rm
2000
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not
_ Ao 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)).
Applicant/Legal Reps. Signature Required? O Yes O No
Applicant/Legal Reps. S
*Issued By: 2140 - Nations, Robert
Authorized State Agent:
Date:
Date of Issue: 0 7/ 1 a/ a 0 1 6
Malfunction Log Oyes
® Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
Minimum Trench Depth:4
*System Classification/Description: -
Inches
TYPE I(A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR
Minimum Soil Cover:
1
LESS)
oZ Inches
- .,
Maximum Trench Depth:
3
6
*Proposed System: 25% REDUCTION
Inches
Maximum Soil Cover:
4
Nitrification Field
8 � 3 � Sq. ft.
Inches
*Distribution Type:
GRAVITY - SERIAL
No. Drain Lines 3
'.'Tota Trench Length: a: 1 8 - 'ft Pump Required: OYes O No O May Be Required
- - Pre -Treatment: O NSF OTS -I OTS -II
*Site Modifications
No grading or. construction activity is allowed in areas designated -fors stem and repair without approval of Health Department. R 3
9 9 tY � 9Y P PP P
750
*Permit Conditions
The issuance of this permit by the Health Department in no guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. Rm
2000
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not
_ Ao 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)).
Applicant/Legal Reps. Signature Required? O Yes O No
Applicant/Legal Reps. S
*Issued By: 2140 - Nations, Robert
Authorized State Agent:
Date:
Date of Issue: 0 7/ 1 a/ a 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
P.O. Box 848
Mocksville NC 27028
Drawing Drawing Type: Construction Authorization
CDP File Number: 218816 - 1
Page 3 of 3
P1 P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital streetCDP File Number: 218816 - 1
P.O. Box 848
Mocksville NC 27028 County File Number:
Date:.0 7./ .1..2 .1016
Click below to import an image from an"external location: Drawing Type: Construction Authorizatir f ��
7c)
Page 3 of 3
1D6-)
P1 P2