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822 Turkeyfoot Rd
r CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 161197- 1 Davie County Health Department E1 -000 -22 -a27 -o1 County ID Number: ft 210 Hospital Street Evaluated For: NEW •aN P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 a/ 1 0 0 a 0 Applicant: Chris Lamb Address: PO Box 1291 City: Mocksville State/Zip: . NC 27028 .Phone #: (336) 963-1247 Address/Road #: Subdivision: Turkey Foot Rd Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: 4 ``Water Supply: NEW WELL /Site Classification: Provisionally Suitable Saprolite System? O Yes 9 No Design Flow: 4 8 0 Soil Application Rate: 0 a 5 *System Classification/Description: *Proposed System: Nitrification Field 1 6 a 0 Sq. ft. Property Owner: Jerry Snyder Address: 156 CV Smoot Lane City: Mocksville State/Zip: NC 27028 Phone #: Phase: Lot: Directions Hwy 64 West, right on Sheffield Rd. Right on Turkey Foot, Property about 2 miles On right look for a sign FOR SaLE by Owner 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: GRAVITY - PARALLEL (eq. d -box) Septic Tank: 1 0 0 0 Gallons 1 -Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Pump Tank: Gallons No. Drain Lines 4 1 -Piece: O Yes O No Total Trench Length: 4 8 0ft. GPM --vs-- ft. TDH Trench Spacing:O Inches O.C. 9 ® Feet O.C. Dosing Volume: Gallons Trench Width: 3 O Inches ® Feet Grease Trap: Aggregate Depth: Gallons inches Pre -Treatment: O NSF OTS -1 O TS -11 Septic Tank Installer Grade Level Required: 01 011 0111 01V rage 'i of j CDP File Number 161197 - 1 County ID Number: E1-000-22-027-01 Kepair System Kequirecl: %& T es v NU v 1140, UUL nab mvallauiu J *Site Classification: Provisionally suitable Design Flow: 4 8 0 Soil Application Rate: 0 a 5 *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Nitrification Field 1 6 a 0 Sq. ft. No. Drain Lines 4 Total Trench Length: 4 8 0 ft. ❑ Open Pump System Sheet Trench Spacing: 9 O Inches O. ® Feet O.C. Trench Width:3 O Inches 9 Feet Aggregate Depth: inches Minimum Trench Depth: .2 4 Inches Minimum Soil Cover: 1 a Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: eC 4 Inches *Distribution Type: GRAVITY -PARALLEL (eq. d -box) Pump Required: O Yes 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 for system and repair without approval of Health Department. Ramanmy 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. ch cf rs 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 O No Applicant/Legal Reps. Signature: Date:. *Issued By: 2140 - Nations, Robert Date of Issue:. 0 . a . / 1 0 0 1 5 Authorized State Age 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: 161197 - 1 County File Number: E1-000-22-027-01 Date: 0,2/ 10 /a015 0 Inch Scale: _ 0 Block \-./ I ........... .................... ......... ...... ..... ...... ... . ........ . . ................ .. . ............ �J- ... ........ ........ . ............ .. ........... .. ---------- ........... . ....... ............ ...... .... . .................. .... ............ .............. .............. ..... ....... ... ....... ........ ............ . ...... . ..... .... .......... ; . ............ .. ........ . .......... ....... .. ..... ... ........ .. . . _......._...i.......__.. ............ ................ .. ...... . ............. ........... ............ ...... ..... .. ...... - - - ------ ----------- - .. .. ......... ............ ............ ... . ....... .... .. ...... ..... ........ ... . ........... ..... ........ .... .. .... ....... ... .................. ............. ........ . ... .......... . .. .. ............. . .......... .. . ... ....... ............. . .. . .......... ------------------------ --- ------ ------ ----- ............ . ......... ... .. .......... ........... 4 ............ :..._....._....w....._._._._`.._.._. --!-._._._.._I ............... ........ .. . ........... .....-- -. .. ........... ....... ................ .............. ......... ... 4 ...................... ........ ..... . .. .......... .. .. .... ... .. ... ............. . ....... ----I--- .......... ............... .... .......... . .. ........... . ........ ............ ................. . . .. . ........ ............ . . ....... ....... .............. ........... . .. .......... ... .. ........... ............. ......... ...... ...... ......... .. ............. .. ... .... .. .. ...... . . .................... ........ . ....... ............. ------- - le ......... ........... .............. .............. . . . . . . . . . . - - - - - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... ..... .... . 7. . ........ . . .............. ............. . . .......... .... . .......... --- - ----- - . ... ...... ............ . . ......... ... . ...... ................. ......... ........ ............ ................ . . .. ......... ............ ............... .. ... ......... 1 ................... ...... ............. .... . .. .. 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I-- .............................................................................. ............. ... .... .. ............................................ ....................................... ..................................................................... Page 3 of 3 Pi P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: 161197 - 1 P.O. Box 848 E1-000-22-027-01 Mocksville NC 27028 County File Number: Date: 0. a/ 1 0 l a 0 1 5 Click below to import an image from an external location: Drawing Type: Construction Authorization Page 3 of 3 P1 P2 Davie County Health Departniellt 4�a f Environmental Health Section._ F.O. Box 848 210 Hospital Street O'r1 Courier #: 09-40-06 e� i Mocksville, NC 27028 Phone: (336) - 753 - 6780 Far. (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: Ok01 . L*k� Phone Number 9Z �a�l � �� (Home) Mailing Address: Q 4 ,rkw �/��h4 I (Work) � ��l`ll k a2cofS Detailed Directions To Site: ^'c` E�l 4-b L i Property Address: Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: �!/' r , _ Type Of Facility: Date System Installed(Month/Date/Year): !'7 Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Y6 No If Yes, For How Long? Any Known Problems? Yes V6-11�if Yes, Explain: 64- Please Please Fill In The Following Information About The NEW Facility: Type Of Facility: 6L,i A , Number Of Bedrooms:__� Number of People Pool Size: T�f garage Size:M (t6 - er: Requested: J0/9-9/ p'( G /� Requested By: For Environmental Health Office Use Only Approve Disapproved Comments: 47av /.g& , r c� I r— Environmental Health Specialist Date: /i% ar `i �/ fG *The signing of this form by the Environm,6ntal Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order Paid By: ,Amount:$ Datc: 6 Received By: Account #: Invoice #: