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234 Bingham & Parks Rd ' OPERATION PERMIT or nice use 051v Davie County Health Department, *CDP.File.Number 1231540-1 �s 210 Hospital Street E7-o0o=1161s -1 t P.O.Box 848 Gaunly ID,Number, Mocksvilie NC 27028: Evaluated,For. HDRNVWC Phone:336-753-6780 Fax:336-753-1680 Township: F ant: Parks and Son Property Owner: Parks and Son ss: 234 Bingham&Parks Road Address: 234 Bingham&Parks Road Advance City: Advance zip: NC 27006 State2ip: NC 27006 Phone#: (336)399-7725 Phone#: (336)399-7725 Property Location & Site information Address/Road#: Subdivision: Phase: Lot: 234 Bingham& Parks Road Advance NC 27006 Directions Structure: BUSINESS Hwy 158 east toward Advance, Road on right #of Bedrooms: #of People: 'Water Supply: N/A 'IP Issued by. *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert SeproliteSystem? QYes Q N o Design Flow: 1 0 0 *Distribution Type: GRAVITY-PARALLEL(eq.d-box) Pump Required? QYes QNo Soil Application Rate: 0 - 3 *Pre Treatment: Drain field FNo. on Field 3 3 3 Sq.ft. 'System Type: INFILTRATOR QUICK 4 STANDARD n Lines 1 Installer. randy Miller Total Trench Length: 4 0 fl. Certification#: Trench Spacing: _ 9 Inches O.C. f Feet O.C. *EH S: 2140-Nations,Robert Trench Width: _ 3 Inches f Feet Date: 0 7 / 2 3 / 2 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Approval-Status Maximum Trench Depth:'3 6 Inches ©:Approved ; Disapproved , , Maximum Soil Cover. 2 4 Inches CDP File Number 123540 - Septic Tank County ID Number: E .00 7.000 .166-11 - Manufacturer Lat. Long: STB: Gallons: Installer. Date: / Certification#: *EHS: *Filter Brand: ST Marker. El Yes ❑ No Date: Reinforced Tank: ❑ Yes ❑ NO ��'" Appival Status'°_ ,a � Piece Tank: �❑ Approv+�d❑ �Dlsapprove� ❑ Yes ❑ N o Pump Tank Manufacturer, Installer. PT: Certification#: Gallons: *EHS: Date: / / Date: RiserSealed ❑ Yes ❑ No RiserHeght: ❑ Yes ❑ No (Min.6 in.) = Approval Status Reinforced Tank: ❑ YeS ❑ No Approved❑ Disapproved 1 Piece Tank: ❑ Yes ❑ No Supply Line Pipe Size: inch diameter Installer Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status ' " ❑ Appe❑ Disapp rovroved 54 Pump Requirement Pump Type: Instafier. Dosing Volume: - Gal Certification#: Draw Down: Inches 'EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve El Yes El No Approval Status; PVC unions El Yes ❑ No ❑ Approved O Disapproved Vent Hole ❑ Yes ❑ No .. .. A. t Anti-siphon Hole ❑ Yes 0 No CDP Fite Number 123540- 1 County ID Number: E7-000-00-166-11 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 13Yes ❑ NO „ Approval Status: Approved❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140-Nations,Robert "Operation Permit completed by Authorized State Agen Date of Issue: 0 7 / 2 3 / 2 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,l5A'NCAC 18A.1900 et Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by.a TYPE It A sewage SeptlC system. Rule.1961 requires that a Type TYPE it A septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: WA Reporting Frequency By Certified Operator.NIA Rule.1.961 requires that a Type 1V and V septic systems designed fora home/business owner.must maintain a valid contract with public management entity,wrth a certified oPeratoror,a private certified operatorforthe life of the septicsystem. 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 bye public_or private management entity,unless the system owner and certified operator are the same, The contract shall require specific requirements form'aartenance 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 Perin it that subsequent owners of the systems execute such a contract. a Hand Drawing 0importDrawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department CDP File Number: 1235#0- 1 210 Hospital Street E7-000-M166-11 P.Q.Box 848 County File Number: Mocksvilie N 27028 Date: { I Qlnch Dralwvin Drawing Type: Operation.Pe it Scale: OBlock 4 4 fir• I CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 123540-1 ..AM, Davie County Health Department E7-000-00-166-11 ,�'�-`•''� tY P County ID Number: 210 Hospital Street Evaluated For: HDR/WWC •tea o,• P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 1 0 / 0 3 / 2 0 1 8 Applicant: Parks and Son Property Owner: Parks and Son Address: 234 Bingham&Parks Road Address: 234 Bingham&Parks Road City: Advance City: Advance State/Zip: NC 27006 State/Zip: NC 27006 Phone#. (336)399-7725 Phone#: (336)399-7725 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 234 Bingham&Parks Road Advance NC 27006 Directions Structure: BUSINESS Hwy 158 east toward Advance, Road on right #of Bedrooms: #of People: *Water Supply: N/A System Specifications Minimum Trench Depth: a 4, Inches rDesign ssification: Minimum Soil Cover: e System? O Yes (9 No Inches Flow: 1 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: GRAVITY-PARALLEL(eq.d-box) TYPE III A.CONV SYSTEM>480 GPD(EXCLUDING SFD) Septic Tank: Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field Sq.ft. Pump Tank: Gallons No. Drain Lines 1-Piece: OYes ONo Total Trench Length: 4 0 ft GPM--vs-- ft. TDH Trench Spacing: g _ Q Inches O.C. Dosing Volume: _ Gallons - 8Feet O.C. Trench Width: _ Inches 817eet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: O NSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01 Oil 0111 ON Page 1 of 3 --CDP File Number 123540 - 1 County ID Number: E7-000-00-166-11 ❑ Open Pump System Sheet Repair System Required:0 Yes O No O No, but has Available Space CDesign System Trench Spacing: IncheSO O.C. fication: Ps — Feet O.C. Trench Width: O Inches w: 1 0 _ O Feet Soil Application Rate: 0 3 Aggregate Depth: inches *System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE III A.CONV SYSTEM>480 GPD(EXCLUDING SFD) Minimum Soil Cover: Inches Maximum Trench Depth: 3 6 Inches *Proposed System: 25%REDUCTION Nitrification Field Maximum Soil Cover: Inches Sq.ft. No. Drain Lines *Distribution Type: GRAVITY-SERIAL Total Trench Length: 8 4 ft Pump Required: OYes ®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 oft Date of Issue: 1 0 / 0 3 / a 0 1 3 Authorized State Agent: �Ouww. Malfunction Log OYes ®Hand Drawing O Import Drawing Total Time:(HH:MM) **Site Plan/Drawing attached.** 0 1 Hours 0 0 Minutes Page 2 of 3 S-10-CA'S issued-repair ` CONSTRUCTION AUTHORIZATION 123540 - 1 Davie County Health Department CDP File Number: 210 Hospital Street E7-000-00-166-11 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 10 / 03 Ix 0 1 3 O Inch Drawing DrawingType: Construction Authorization Scale: , O Block = ft. YP Q N/A Q 0 - / AL sty I New ��xiboi3 Page 3of3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 123540 - 1 P.O.Box 848 E7-000-00-166-11 Mocksville NC 27028 County File Number: Date: .1 0./ .0.3. / .2 0 1.3. 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