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156 Hoose Ln (2) OPERATION PERMIT or ice se ny rte. Davie County Health Department *CDP File Number 123581 -1 210 Hospital Street Ks-000-oaoss-ot P.O.Box 828 County ID'Number. Mocksville NC 27028 Evaluated For EXPANSION Phone:336-753-6780 Fax:336-753-1680 Township:; Applicant: Brett McMahan/McMahan Septic Property owner: Federal Home Loan Mortage Address: 10 Paddington Drive Address: City: Lexington City: State2ip: NC 27295 StatefLip: Phone#: (336)491-1558 Phone#: Pro a Location & Site Infonnatlon rAddress/Road #: Subdivision: Phase: Lot: 6 Hoose Lane ocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy601 S. Left on Deadmon, Right on Will Boone Rd. then left on Hoose Lane #of Bedrooms: 3 #of People: -Water Supply: PUBLIC *IP Issued by. *System Class ification/Description: TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP *CA issued by: SeproliteSystem? QYes ONo Design Flow: 3 6 0 PUMP TO GRAVITY Pump Required? Distribution Type: {y Yes QNo Soil Application Rate: 0 3 *Pre Treatment: Drain field rcation Field 1 2 0 0 Sq.ft. *System Type: EZFLOW EZ 1003T rain Lines 4 Installer: Brett McMahan Total Trench Length: 3 0 0 ft• Certification#: 1120 Trench Spacing: _ 9 2inches O.C. Feet O.C. *EH S: 2140-Nations.Robert Trench Width: _ 3 Inches Feet Date: 0 2 I 1 9 ! 2 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches 77-7 77-7 7-77,7 Minimum Soil Cover 4Inches ApprovatStatus, Maximum Trench Depth: 3 6 Inches ® Approved L7` Disapproved Maximum Soil Cover. 2 4 Inches CDP Fite Number 123581 - 1 Septic Tank County ID Number: K5-000-WW5.01 Manufacturer. Shoaf Lat. , STB: 760 Long: Installer. Brett Mcmahan Gallons: 1000 Certification#: 1120 Date: 0 ? / 1 6 / x 0 1 3 , "EHS: 2140-Nations,Robert 'Filter Brand: POLYLOK PLA 22 With Pipe Adapter ST Marker. El Yes 0 No Date: .0 _ a 11 9 I � 0 1 4 Approvat Status Reinforced Tank: ❑ Yes [B No 1 Piece Tank: ❑ Yes No ® Approved[ Disapproved Pump Tank Manufacturer. Shaof Installer. Brett McMahan PT: Certification#: 1120 Gallons: 1000 *EHS: 2140-Nations,Robert Date: 0 8 I a 1 / 2 0 1 3Date: 0 2 ! 1 9 I a 0 1 4 RiserSealed Q Yes" ❑ No RiserHeight: [l Yes ❑ No (Min.6 in.) j Approval Status Reinforced Tank: p Yes ❑ No ® Approved❑ Disapproved 1 Piece Tank: ® YeS _ ❑ No __ Supply Line Pipe Size: 2 inch diameter `,installer. Brett McMahan Pipe Length: 1 7 0 feet Certification#: 1120 'EHS: 2140.Nations.Robert "Schedule: 40 Pressure Rated ® Yes ❑ No - Date: 0 a / 1 9 / 2 0 1 4 Approved fittings ® Yes _ ❑ NO i Approval Status {� Approved❑ Disapproved Pump : Zoeter Installer Brett McMahan rDos7inge: - Gal Certification#: 1120 n: Inches 'EHS: 2140-Nations.Robert *Chain: ROPE 0 . ! 1 9 12 0 1 4 Date: Valves Accessible p Yes ❑ NO Flow Adjustment Valve 0 Yes ❑ No Check-valve ® Yes ❑ No AppravatStatus= PVC unions ] Yes ❑ No ® Approved❑ Disapproved' Vent Hole 0 Yes ❑ No Anti-siphon Hole Q Yes 0 NO CDP Fite Number 123581 - 1 County ID Number: KS-000-00.065-01 Electric E ui ment NEMA4XBoxorEquivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ No Box Adj.To Pump Tank Certification#: ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Approval Status Alarm Audible ❑ Yes ❑ No ❑, Approved❑ Dlsappruired j Alamt visible ❑ Yes ❑ NO 2140-Nations,Robert *Operation Permit completed by: ,J Authorized State Agent: ,;= Date of Issue: 0 a / 1 9 / 2 0 1 4 Owner/Applicant Signature: This system has been installed incompliance 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 B. sewage septic system. -- Rule.1961 requires that a Type 1YPE III B. septic system meet the following criteria: Minimum System Review By The Local Health Department: SYRS. Management Entity: OWNER Minimum System InspectionlMaintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator.NIA 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 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 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. ®Hand Drawing 0Import Drawing **Site Plan/Drawing attached.** I I OPERATION PERMIT 123581 - 1 Davie County HealthDepactment CDP File Number: 210 Hospital Street KS-000-00.065-01 P.O.Box MCounty File Number: Mocksville NC 27028 Date: J j O Inch Scale: O Drawing DrawO Drawing Type: Operation Permit OBlock = , ft. f � G A I I � ii I I I ; I C CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 123581 -1 ..A�o Davie County Health Department County ID Number: K5-000-00-065-01 210 Hospital Street Evaluated For: EXPANSION P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 1 0 1 1 / a 0 1 8 Applicant: Bre•f McMahan/McMahan Septic Property Owner: Federal Home Loan Mortage Corp. Address: 10 Paddington Drive Address: City: Lexington City: State/Zip: NC 27295 State/Zip: Phone#: �33491-1558 Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 156 Hoose Lane Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 601 S. Left on Deadmon, Right on Will Boone Rd. then left on Hoose Lane #of Bedrooms: 3 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: 1 4 rDesign fication: Ps Inches System? Minimum Soil Cover: y O Yes 9 No Inches w: 3 6 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . 3 Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: PUMP To GRAVITY TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: O Yes O No O May Be Required Nitrification Field Sq.ft. Pump Tank: 1 0 0 0 Gallons No. Drain Lines 1-Piece: OYes ®No Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH Trench Spacing: g _ O Inches O.C. Dosing Volume: Gallons _ 8Feet O.C. Trench Width: 0Inches O Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: O NSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: O 1 O II 0111 O IV Page 1 of 3 CDP File Number 123581 - 1 County ID Number: K5-000-00-065-01 ❑ Open Pump System Sheet Repair System Required:®Yes O No O No, but has Available Space rDesignFlow: System Trench Spacing: O Inches O.C. fication: — O Feet O.C. Trench Width: O Inches _ - 8Feet Soil Application Rate: Aggregate Depth: inches .� *System Classification/Description: Minimum Trench Depth: Inches Minimum Soil Cover: . Inches Maximum Trench Depth: *Proposed System: Inches Maximum Soil Cover: Nitrification Field Inches No. Drain Lines Sq.ft. *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(A 937(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 ®No Applicant/Legal Reps.Signature: Date: *Issued By: 2244-Daywalt,Andrew Date of Issue: 1 0 / 1 1 / a 0 1 3 Authorized State Agent: 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-9-CA'S issued-expansion CONSTRUCTION AUTHORIZATION 123581 - 1 Davie County Health Department CDP File Number: 210 Hospital Street County File Number: K5-000-00-065-01 P.O.Box 848 Mocksville NC 27028 Date: 10 / 11 / 2013 O Inch Drawing Drawing Type: Construction Authorization Scale: , O Block O N/A 'l 2v4 10 �D V G. 'i verb' au W OA�M C�avt�4 Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 123581 - 1 P.O.Box 848 K5-000-00-065-01 Mocksville NC 27028 County File Number: Date: .1 0,/ 11 / x 0 13 Click below to import an image from an external location: Drawing Type:Construction Authorization Page 3 of 3 P1 P2 09/20/2013 15:15 3363007590 MCMAHAN SEPTIC TANK PAGE 01/02 Y. APPLICATION APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental:Health 1tECE � PA Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-67801 Fax(336)753-1680 Application For: 0 Site Evaluation/Irnprovement Permit I I Authorization To Construct(ATC) 4:J Both Type of Application: ClNew System HRepair to Existing System h xpansionlModification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT Bir PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT.INFORMATION II Name tIC.`Cont ct Person Address Av , Home Phone City/State/ZiP -NCBusiness Phone Email o nr-� Email:_th _m_ _e Name on Penmit/ATC if Dr:fferent than AboWe Mailing Address City/State/Zip PROPERTY INFORMATION *Date Iiouse/Facility Corners Flag red NOTE: A survey plat or site plan must accompany this application. Included: n Site Plan . lat(to scale) (Permit is valid for 60 months w' site lan,no ex iration with mplete plat.) Owner's Name r e Phone Number. - Owner's Address +h City/State/Zip f1 C Property AddressCity_1C{ �V 11 Lot Size Tax PIN# 6,01 1<6-006-00-0�0 Subdivision Name(if applicable) Section/Lot## ' 0v Directions To Site: If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? /yes _No Does the site contain jurisdictional wetlands? —Yes ✓No Are there any easements or right-of-ways on the site? _Yes ^0 Is the site subject to approval by another public agency? _Yes ✓No Will wastewater other than domestic sewage be generated? Yes �/No ``__ IF RESIDENCE FILL OUT THE BOX BELOW I nT #People _ #Bedrooms #Bathrooms�� Garden Tu /Whirlpool Elves 11No Basement: /.!Yes iyNo Basement Plumbing: ClYes .%.No IF NON-RESEDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Nater Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: Seats Type system requested: Iveonventional . /Accepted I linnovative L!Alternative 1'.Other_ Water Supply Type: SI County/City Water i I New Well G1 Existing Well I I Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?C;Yes Io if yes,what type? 14iy e�,c ht L{re,p kt j (X. — ltknn •09/20/2013 15:15 3363007590 MCMAHAN SEPTIC TANK PAGE 02/02 3►TeMahan Septic 1kak,Inc. l0 Paddington Drive Lexington NC 27295 56 1 l z X. CN 156 loose bene Mocksville s+.I - NC 27028 Printed:Sep 20, 2013 AN data ls provided We without warranty or guarantee of any kind elmer expressed or Implied Including but not pmlted to the}maned warranties of merchantability or fitness for A particular use.All users of Davie County's GI$website shall hold harmless the County of Davie,North Carolina, Its agents,consmtarim,contractors or employees from any and as claims or cause:or action due to or arising out of tho use or inability to use Vie 013 data provided by this website. Appraisal Card Page 1 of 1 • , h DAVIE COUNTY NC 10/1/2013 9:06:55 AM EDERAL HOME LOAN MORTAGE CORP Retum/Appeal Notes: KS-000-00-066-03 156 HOOSE LN UNIQ ID 20547 2530559 NN:26-CHANGE OF OWNERSHIP D305-P24 ID NO:5747814772 COUNTY TAX(100),FIRE TAX(100) CARD NO.I of I eval Year:2013 Tax Year:2014 1.19 AC N OFF WILL BOONE 1.440 AC SRC-Owner %ppralsed by 19 on 05120/2008 05004 FAIRFIELD TW-05 C- EX-AT- LAST ACTION 20130919 :n CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE m O oundatlon-3 Eff. BASE Standard 0.2700 m ontinuous Footing5.0 US MO Area UA RATE RCN EYB AYB CREDENCE TO MARKET ub Floor System-4 ood 8 0 59 01 11,907110 3 72.10 137495198 198 %GOOD 73.0 EPR.BUILDING VALUE-GRD 100,37 erior Walls-30 TYPE:Modular Single Family Residential EPR.OB/XF VALUE-GRD 2 Iuminum n I Siding29.0 MARKET LAND VALUE-GRD 13,02 m oofing Structure-03 STORIES:1-1.0 Story OTAL MARKET VALUE-GRD 113,41 O able 8.0 L oofing Cover-03 ksphaft or Composition Shin le 3.0 OTAL APPRAISED VALUE-GRD 113,41 p OTAL APPRAISED VALUE-PARCEL 113,41 nterior Wall Construction-5 )rywall/Sheetrock 20.0 n nterior Floor Cover-OB TOTAL PRESENT USE VALUE-PARCEL C ^r heet Vin 1 Laminate 6.0c TOTAL VALUE DEFERRED-PARCEL O nterior Floor Cover-14 TOTAL TAXABLE VALUE-PARCEL 113,41 F :arpet 0.0 +----25----+ 9 eating Fuel-03 I U B M I PRIOR as 1.0c I I 3UILDING VALUE 103,85 eating Type-04 1 I BXF VALUE 10 orced Air-Ducted 4.0 I 1 D VALUE 13,02 r Conditioning Type-03 C C RESENT USE VALUE entral 4.0 - 1 1 EFERRED VALUE 3edrooms/Bathrooms/Half-Bathrooms I I OTAL VALUE 116,970 2/0 12.000 1 1 rooms S-3FUS-0 LL-0 throoms +--1 6--+ PERMIT S-2 FUS-0 LL-0 I W D D z CODE I DATE I NOTE I NUMBER AMOUNT ffice 1 1 -OFUS-OLL-O 4 4 +----28-----+--16--+-12-+ OUT:WTRSHD: OTAL POINT VALUE 100.00 I B A S I SALES DATA BUILDING ADJUSTMENTS 1 I FF. INDICATE uali 3 AVG 1.000 0 1 RD DEED SALES 9 ha Dest 4 FACTOR 1.050 +4+ I 1 5 1 P 3 1';�MCO �61 R TYPE PRICE ize 3 Size 0.980 0 0 0 01 TD P I M OTAL ADJUSTMENT FACTOR 1.03 +4+ I 98 WD U V 300 7C OTAL QUALITY INDEX 10 1 I cn 1 I v 0 1 0 +-----33------+-12-+-11-+ o 1 W D D 1 HEATED AREA 1,680 0 0 0 0 +-12-+ NOTES c OWNER 0 FROM CHARLES V HOOSE SR r. SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR GS DE�EICRIPTIO LT NIT PRICE COND LOG B AYB EYB RATE V COND VALUTYPE AREA %RPL CS 4 D 101 8 5.1 10 L 194 199 S 1 2 168 10 12112 OTALOB XFVALUE 2 4 2 57 BM 75 2 1081 DD 3 20 497 RREE 1-None 2,81 137,49DIMENSIONS BAS-W12WDD-N14W16S14E16 W44SIOSTP=W4S10E4N10 S20E33WDD-SIOE12N10W12 E23N30 PTR-N50 UBM=S30E25N30W25$S50 . RMATION THER ADJUSTMENTS LAND TOTAL USE LOL FRON DEPTH/ LND COND ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND CODE ZONING TAGE EPT SIZE MOD FACT RFACLC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTEST 02010 0 2.0410 4 0.7500 30-15+00+00+00 PD 5 900.0 1.441 AC 1.531 9 032.9 1301RKET LAND DATA 1.441 13,02 OTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=K50000006601 10/1/2013 ,f DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `NOTE: Issued in Compliance with G.S.of North Carolina Chapter 130 Article 13c Sewage Treatment an isposal Rules (10 NCAC 10A.193 -.19`68r)- Permit Number Name 4,''C �QI�- `�"—��' Date "L t �'. 7 j Location IM-0 Subdivision Name 1669 h�6S8,Lyl Lot No. Sec.or Block No. Lot Size I House Mobile Home Business Speculation No.Bedrooms _No.Baths No.in Family Garbage Disposal YES Q NO Sp/ecifications for System: Auto Dish Washer YES NO ❑ 6"v 00 gCcQ U`""Q"2'� �6x Auto Wash Machine YES NO ❑ Type Water Supply- C�h V �v ' S x Z, 'This permit Void if sewage system described below is not Installed within 36 months from date of issue. t Improvements permit by 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number:704-634-5985. Final Installation Diagram: System Installed by ' " F D�ve, Certificate of Completion Date 'The signing of this certificate shall Indicate that the system described above has been installed In compliance with the standards set forth in the above regulation,but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. i� too I\ bJ�. ► 1 � �