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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