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131 Dandelion Ln OPERATION PERMIT or ice use nv Davie County Health Department *CDP File Number 229591 1,. - 210 Hospital Street - P.O. Box 848 County ID Number. Mocksville NC 27028 Evaluated For REPAIR Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Margaret Garretson Property owner: Margaret Garretson Address: 2107 Comatzer Rd Address: 2107 Cornatzer Rd CRY: Mocksville City: Mocksville State2ip: NC' 27028 State2ip: NC 27028 Phone#: (336)940-3801 Phone#: (336)940-3801 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 2107 Cornatzer Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY H 64 East left on Comatzer Rd #of Bedrooms: #of People: *Water Supply: NIA *IP Issued by *System Class ification/Description: " TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations.Robert Seprolite System? 0Yes (}No Design Flow: a 4 0 __ . * GRAVnY-SERIAL p Required? Distribution Type: Pum Re uir Soil Application Rate: QYes ( No 0 a 7 5 *Pre Treatment: Drain field Nkrification Field 8 7 3 Sq.ft. *System Type: INFILTRATOR ClUICK 4 STANDARD No. Drain Lines 4 Installer: Randy Miller Total Trench Length: a 1 8 Certification#: 1128 Trench Spacing: _ 9 Inches O.C. ()Inches O.C. 'EH S: 2140-Nations.Robert Trench Width: 3 Inches - QDFeet Date: 0 9 / 0 8 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches ApprCilat Status Maximum Trench Depth: 3 6 Inches Approved D Disapproved Maximum Soil Cover. a 4 Inches ;-,9 CDP Fite Number 229591 - 1 County ID Number: Septic Tank Manufacturer. Lat. Long: STB: Gallons: Installer Date: Certification#: •___,._.... *EHS: *Filter Brand: ST Marker. ❑ Yes ❑ No Date: Reinforced Tank: ❑ Yes ❑ No Piece Tank: O Yes ❑ ND C Ap�aror�ed❑ t eppro e Q �y Pump Tank Manufacturer. Installer _ PT: Certification#: Gallons: 'EHS: _Date: I / Dater , RiserSealed ❑ Yes ❑ No RiserNeght: EJ ❑ No (Min.6 in. einforced Tank: El Yes ❑ N o Cl�ApprovedD�Drsapprove��f /- 1 Piece Tank: ❑ Yes ❑ No SUpply Line Poe Size: Inch diameter Installer Pipe Length* feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings O Yes ❑ Na App"roSralStatus d roVe ❑�Dlsapproved , 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 Appmvat'Status PVC Unions ❑ Yes ❑ No ' © 1ppoved❑ Q­ Vent Hole ❑ Yes ❑ No j Anti-siphon Hole Q Yes ❑ No CDP File Number 229591 - 1 County ID Number: Electric E ui ment NEMA4XBox orEquivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes C1 No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Approval Status Alarm Audible ❑ Yes ❑ No _ ,D Approved� Drsapproved y Alarm Visible ❑ Yes ❑ No 2140-Nations.Robert *Operation Permit completed by: Authorized State AgenDate of Issue: 9 / 0 8 / 2 0 1 6 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 Permit and Construction Authorization.This.property is served by a TYPE UA sewage septic system. Rule.1961 requires that a Type TYPE►I A septic system meet the following criteria: Minimum System Review ByThe Local Health Department: WA Management Entity: OWNER - - - Minimum System Inspection/Maintenance Frequency By Certified Operator. NIA Reporting Frequency By Certified Operator WA Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public 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 bya public or private management entity,unless the system ownerand 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 condition of the Operation Permit that subsequent owners of the systems execute such a contract. Q Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department CDP File Number: 229591'- 1 290 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: / Q Inch Scale: . OBlock Drawin Drawing Type: Operation Permit ON/A Ir I-� C-1r El T--1 41:1 7——F IS fi I I1 1 4 CONSTRUCTION For Office Use Oniy AUTHORIZATION *CDP File Number 229591 -1 eb- - Davie Coun Health De artment tY P County ID Number.210 Hospital Street Evaltd FrREPAIR P.O. Box 848 �Townshlp-"' Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 8 / a 4 / a 0 a 1 Applicant: Margaret GarretsonProperty Owner. Margaret Garretson Address: 2107 Comatzer Rd Address: 2107 Comatzer Rd City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)940-3801 Phone#: (336)940-3801 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 2107 Comatzer Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY, Hwy 64 East left on Cornatzer Rd #of Bedrooms: #of People: *Water Supply: NSA System Specifications Minimum Trench Depth: a 4 rSaprolite ssification: Provisionally Suitable Inches Minimum Soil Cover: System? O Yes f&No 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: Septic Tank: Gallons *Proposed System: 1-Piece: O Yes O No Pump Required: O Yes O No O May Be Required Nitrification Field 8 7 3 Sq.ft. Pump Tank: Gallons No. Drain Lines 4 1-Piece: OYes ONo Total Trench Length: 2 '1 8 ft GPM--vs— ft. TDH Trench Spacing: Inches O.C. 9 Feet O.C. Dosing Volume: _ Gallons Trench Width: — 3 O 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 ON Page 1 of 3 CDP File Number 229591 - 1 County ID Number: ❑ Open Pump System Sheet Repair System Required:0 Yes ONO ONO, but has Available Space CDesign System Trench Spacing: O Inches O. . ification: — O Feet O.C. Trench Width: O Inches w: — O Feet Aggregate Depth: Soil Application Rate: inches .� Minimum Trench Depth: *System Classification/Description: 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 dws No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rang 750 *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder Mwad is responsible for checking with appropriate governing bodies in meeting their requirements. R"ainBfB anrning 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 ONO Applicant/Legal Reps. Signature, Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 8 a 4 / 2 0 1 6 Authorized State Agent: Malfunction Log OYeS Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 i • CONSTRUCTION AUTHORIZATION 228591 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 08 / ,24 / .2016 O Inch Drawing -Drawing Type: Construction Authorization Scale: . O Block ..........._,...._............................_,..................._._.........,.................................................................. ............................................... ........ O N/A I � I I I a .11L , _ I i... I ! . ......... . . I I I I I I I I i , r... I... , I j I , .................II I I � I i I I ' i I I I i i i .. 1 -- 1 I � , I. a.. !............ .. .j....................... ....... 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' ` ... ........ ... : ' I � I I. ....... 1 z� I j I I l i .... . j ...... .... ........ ........ ........:. ... l I ... .. .. Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION i Davie County Health Department 210 Hospital Street CDP File Number: 229591 - 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: .0.8./ .a.4. a 0 16 Click below to import an image from an external location: Drawing Ty :Construction Authorization �MaT 1fLe �cj 6 J/1 69 1 �3 Page 3 of 3 P1 P2 %