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333 Ashley Furniture Way OPERATION PERMIT or nice use UnIv Davie County Health Department *CDP.Fila Number 123122-1 210 Hospital Street F7400a-00-018 P.O. Box 848 County ID Number: '`°-• Mocksville NG 27028; Evaluated.For: REPAIR Phone:336-753-6780 Fax:336-753-1680 Township; F ant:, Ashley Furniture Ind. PropertyOwner. Ashleyfurniture Ind., Inc. ss: C/Q Michael Hauser, Facility Address: One Ashley Way yAdvance City: Arcadia StateJZiP: NC 27006 State/Zip: WI 54612 Phone#: Phone#: Property Location & Site Information r dress/Road#: Subdivision: Business Phase: Lot: 333 Ashley Furniture Way Advance NC 27006 Directions Structure: BUSINESS Hwy 158, toward Advance.Tum right on Baltimore Rd. Ashley Furniture on Right. #of Bedrooms: #of People: `Water Supply: PUBLIC 'IP Issued by. *System Class'rfication/Descdption:. TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP *CA issued by: Saprolde System? QYes �)No Design Flow: Pump Required? 3 0 0 "Distribution Type: PUMP TO GRAVITY QYes QNo Soil Application Rate: 0 a *Pre Treatment: Drain field rNo. cation Field 1 5 0 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD rain Lines 4 Installer: Donnie Lakey TotaTrench Length: 5 1 4 8. Certification#: Trench Spacing: _ 9 ()Inches O.C. +r .�. Feet O.C. *EH S: 2140-Nations.Robert Trench Width: _ 3 ©Inches (DFeet Date: 0 2 / 1 3 / 2 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. Stus a 4 Approvalat � Inches . Maximum Trench Depth:'3 6 ®°Approved O ©Isapproved _ Inches Maximum Soil Cover: a 4 Inches CDP Fite Number 123122 - 1 Septic Tank County ID Number F7-oaD-00-oa8 Manufacturer Lat. Long: STB: Gallons: Installer. Date: / / Certification#: *EH S: "Filter Brand: ST Marker. El Yes ❑ No Date: ; -Appi'ova�Sfatus �; �_ Reinforced Tank: ❑ Yes ❑ NO 1 Piece Tank: O Yes ❑ No ❑ ApprovedDisapproved Pump Tank Manufacturer, Shoal Installer Donnie Lakey PT: 964 Certification#: Gallons: 1500 THS: 2140-Nations,Robert Date: 0 9 / 1 g / a 0 1 3 Date: 0 2 / 1 3 / a 0 1 4 RiserSealed Q Yes ❑ No RiserHeght: ® Yes ❑ NO (Min.6 in.) W' °Approval Status el Tank ❑ Yes O No .:"� Approved❑ Disapprovedr 1 Piece Tank: ® Yes ❑ No � Supply Line Pipe Size: inch diameter Installer, Pipe Length: feet Certification#: *Schedule: *EH S. Pressure Rated ❑ Yes ❑ No Date: Approved fittings [I Yes El No Approval Status ❑ AP "Oed® ,QJsappr� ve+d Pump Requirement (' Pump Type: Installer, Dosing Volume: - Gal Certification#: Draw Down: Inches 'ENS. *Cham: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment valve ❑ Yes ❑ No Check valve ❑ Yes ❑ NO 3 Approval Status Pvc unions ❑ Yes ❑ No, ❑ 1Appfoved❑ Disapproved Vent Hold ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No . .. .. .......... ... . .. . CDP'File Number 123122 - 'I County ID Number: F7-000-00-01$ Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ NO Certification#: Box Adj.To Pump Tank ❑ Yes ❑ NO Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Alarm Audible ❑ Yes ❑ NO APPruyat Status Approved❑ D"approved Alarm Visible ❑ Yes ❑ No r 2140-Nations.Robert *Operation Permit completed by; Authorized State Agent: Date of Issue. 0 / 1 3 / 0 1 4 Owner/Applicant Signature: 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, Pemtlt and Construction Authorization.This property is served bye TYPE ltl B. sewage Septic system. Rule.1961 requires that a Type TYPE 1118• septic system meet the following criteria: Minimum System Review ByThe Local Health Department: 6YRS. Management Entity: OWNER Minimum System Inspectionwlaintenance Frequency ByCertified Operator. NIA Reporting Frequency By Certified Operator.NIA Rule.1961 requires that a,TYPe 1V and V septic sYstems designed fora home/business owner must maintain a valid contract with apublic management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business 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,finless the System owner and certified operator are the same. The contract shall require specific requirements formantenance and operation,responsibilities of the owner and systems operator,provisions that the contract shalt be in effect for as long as the system is in use,and other requirements forthe: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. iMand Drawing 41mport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT ' Davie County Health Department CDP File Number: 123122 ' 1 210 Hospital Street F7-000-00-018 P.O.Box 848 County File Number: Mocksville NC 27028 Date: / J Q inch Drawing ON/A Drawing Type: Operation Permit Scale: = ft. Q N! VT l AV �S0 V CAi, • CONSTRUCTION For office Use Only AUTHORIZATION *CDP File Number 123122- 1 Davie County Health Department 177-000-00-018 tY P County ID Number. t 210 Hospital Street Evaluated For: REPAIR •o; P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 9 / 0 5 / 2 0 1 8 Applicant: Ashley Furniture Ind. Property Owner. Ashley Furniture Ind., Inc. Address: C/O Michael Hauser, Facility Address: One Ashley Way City: Advance City: Arcadia State/Zip: NC 27006 StatefZip: Wl 54612 Phone#: Phone#: Property Location & Site Information Address/Road#: Subdivision: Business Phase: Lot: 333 Ashley Furniture Way Advance NC 27006 Directions Structure: BUSINESS Hwy 158, toward Advance.Tum right on Baltimore Rd. #of Bedrooms: Ashley Fumiture on Right. #of People: *Water Supply: PUBLIC System Saecifications Minimum Trench Depth: 4 8 Site Classification: PS Inches Minimum Soil Cover. SaproliteSystem? OYes (9No Inches Design Flow: 3 0 0 Maximum Trench Depth: 4 8 Inches Soil Application Rate: 0 a Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE 11 B.CONY.SYSTEM WITH 750 LINEAR FEET OF NITRIFICATION LINE OR LESS Septic Tank: Gallons *Proposed System: CONVENTIONAL 1-Piece: O Yes O No Pump Required: i&Yes O No O May Be Required Nitrification Field Sq.ft. Pump Tank: 1 5 0 0 Gallons No. Drain Lines 1-Piece: OYes (&No Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH Trench Spacing: Inches O.C. g O.C. Dosing Volume: Gallons Feet Trench Width: 0Inches O Feet Grease Trap: Gallons Aggregate Depth: a 4 inches Pre-Treatment: O NSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: 01011 O III ON Page 1 of 3 CDP File Number 123122 - 1 County ID Number: F7-000-00-018 ❑ Open Pump System Sheet Repair System Required:0 Yes O No O No, but has Available Space rDesign System Trench Spacing: Inches O.C. ification: — 8 Feet O.C. Trench Width: O Inches w: O Feet Aggregate Depth: Soil Application Rate: inches u *System Classification/Description: Minimum Trench Depth: Inches Minimum Soil Cover: Inches Maximum Trench Depth: *Proposed System: Inches Maximum Soil Cover. Nitrification Field Inches Sq.ft. No. Drain Lines *Distribution Type: Total Trench Length: 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 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 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(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 ®No Applicant/Legal Reps. Signature: - Date: *Issued By: 2244-Daywalt,Andrew Date of Issue: 0 9 0 5 / a 0 1 3 Authorized State Agent: Malfunction Log (&Yes ®Hand Drawing O Import Drawing Total Time:(HH:MM) **Site Plan/Drawing attached.** 1 Page 2 of 3 Hours 0 0 Minutes S-10-CAS issued-repair CONSTRUCTION AUTHORIZATION 123122 - 1 Davie County Health Department CDP File Number: 210 Hospital Street F7-000-00-018 P.O.Box Bas County File Number: Mocksville NC 27028 Date: 09 / 05 / .2013 O Inch Drawing Drawing Type: Construction Authorization Scale: , O Block O N/A a��� 31 3 -3 �v sck fu /u� e✓ �oJap aox 1 .1 0 Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 123122 - 1 P.O.Box 848 F7-000-00-018 Mocksville NC 27028 County File Number: Date: A9./ 0 5 / a 0 13 Click below to import an image from an external location: Drawing Type:Construction Authorization Page 3 of 3 P1 P2