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193 Flat Mtn Trail
Davie County,NC Tax Parcel Report Thursday, February 23, 2017 I 5k I -j �i2 �� f 0:r ................_.......... _...... "....._..................._.._.......__.. r---,.. .._...............__..........:..._..._....................................................................._1......................_................................................._..�. _.....__....................... WARNING: THIS IS NOT A SURVEY Parcel;Information Parcel Number: F10000001212, Township: Clarksville NCPIN Number: 4891924804 Municipality: Account Number: 8303140 Census Tract: 37059-801 Listed Owner 1: PHELPS LUKE GRANVILLE Voting Precinct: CLARKSVILLE Mailing Address 1: 206 TANNIN WAY Planning Jurisdiction: Davie County City: LEXINGTON Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27295 Voluntary Ag.District: No Legal Description: 53.56 AC OFF SHEFFIELD RD(48.50 AC) Fire Response District: SHEFFIELD-CALAHALN Assessed Acreage: 48.70 Elementary School Zone: WILLIAM R DAVIE Deed Date: 2/2014 Middle School Zone: NORTH DAVIE Deed Book/Page: 009500445 Soil Types: PaD,PcC2,CeB2 Plat Book: 12 Flood Zone: Plat Page: 185 Watershed Overlay: DAVIE COUNTY Building Value: 233410.00 Outbuilding&Extra 0.00 Freatures Value: Land Value: 161720.00 Total Market Value: 395130.00 Total Assessed Value: 254250.00 a Ay�A All data is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �Obpl� NC or arising out of the use or inability to use the GIS data provided by this website. I � OPERATi6N PERMIT EE, vaivated iceOW-0-51V Davie County Health Department Number 220019-1 f 210 Hospital Street 4891924804 County umber. ._P.O.Box 848- � Mocksville -- NC 27028 r. NEW Phone: 336-753-6780 Fax:336-753-1680 _, Applicant: :Built Green Ind Property Owner: Luke Phelps Address: PO Box 1345 Address: 206 Tannin Way City: .Salisbury City: Lexington _.-:,.StatefLip: NC 28145 .:State/Zip: NC 27295 Phone#: (704);202-1540 Phone#: (336)408-2048 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Rocking Chair Lane Mocksville NC 27028 Directions structure a SINGLE FAMILY v .Hwy,64 West to Sheffield Road toward end right on _.. _ Sheffield Farm Trail. Turn Rocking Chair Lane site on #_of Bedrooms: 4 Right #of People: i *Water Supply: PUBLIC *IP Issued by 2140-Nauoiis;Robe�t `System Class ifiicatan/Description: _ - - 'TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS *CA issued by: 2140-Nations,Robert - SaproliteSystem? OYes ONo Design Flow 4- 8 0 GRAVITY-SERIAL Pump Required? . Distribution Type: Q Yes («jNa Soil Application Rate: 0 3 *Pre Treatment: Drain field Nitrification Field 1 6 0 0 Sq.ft. *System Type: INFILTRATOR QUICK STANDARD No. Grain Lines 3 Installer: Randy Miller Total Trench Length 4 0 0 ft. Certification#: 1128 Trench Spacing: — 9 Inches O.C. Feet O.C. *EH S: 2310-Debra Harmon Trench Width: 3 Inches Feet Date: 1 0 / a 7 / .1 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 inches MNIM 8N NK I I I I � I i III i, I CDP File Number 220019 - 1 Septic Tank County ID Number: 4891924804 Manufacturer. Shoaf Lat. STB: .760 Lang: - Randy Miller Gallons: 1000 Installer y Certification#: 1128 Date: 0 8 / 2 1 / 2 0 1 6 "EHS: 2140-Nations.Roger! 'Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter ST Marker. El Yes No � Date: 1 0 / 2 7 Status l a 0 1 6 � - - - Reinforced Tank: El Yes ® No Approval 1 Piece Tank: ® Approved El;.Disapproved Pump Tank C.Manufacturer. InstallerPT: Certification#: ;Gallons: 'EHS: Date: / / Date: RiserSealed ❑ Yes ❑ No Riser Height: ❑. YeS ❑�Np (Min.B in.) Approval Status Reinforced lank: ❑ Yes EL-No - 'p'Approved O°Disappi oved. a. . 1 Piece Tank: ❑ .Yes ❑. No Supply Line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: *Schedule: 'EH S: Pressure Rated -[I- Yes _. ❑ NO Date: Approved fittings [1-Yes, ❑ No Approval Status, -Approved O Disapproved Pump Requiremelit Pump Type: Installer. Dosing Volume: — Gal Certification#: Draw Down: Inches *EHS' 11 220019 - 1 4891924804 CDP File Number County ID Number: Septic Tank r�M;anufact7urer Shoat Lat. 760 Long: Gallons: 1000 ;Installer: Randy Miller - Certification#: 1128 Date: 0 8 / a 1 / a 0 1 6 'EH S: 214D-Nations.Robert 'Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter ST Marker 13 Yes M No Date: 1 0 / a / a 0 1 6 A Reinforced Tank: ❑ Yes pproval ® No - Status Piece Tank: El Yes [ No ® Approved❑= Disapproved.. Pump Tank Manufacturer Installer. PT: Certification#: `_Gallons: "EH S: Date: Date: / RiserSealed ❑ Yes ❑ No i - ❑ `NRseHo (Min.6,in.) ,.- Approval Status Reinforced Tank ❑ Yes : ❑-.No a Approvetl❑g,Disapprovetls 1 Piece Tank: ❑ Yes.__ ❑_Y No . Supply Line Poe Size: inch diameter Installer. - Pipe Length: feet Certification#: "Schedule: "EHS: Pressure Rated_ ❑..Yes ❑ NO Date: Approved fittings ❑ _YeS _: ❑ No Approval Status r ; - 4 C7 isa Approved❑ :Droved • pp PuMp Requirgement Pump Type: Installer: Dosing Volume: — Gal Certification#: Draw Down: Inches 'EHS: 'Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check-valve ❑ Yes ❑ NoApproval status PVC unions El Yes El No ❑ Approvetl❑ Disapprovetl Vent Hole ❑ Yes ❑ No Anti-siphon Hole El Yes 0 No OPERATION PERMIT or ice se ny Davie County Health Department *CDP File Number 220019-1 210 Hospital Street 4891924804 P.O. Box 848- ... County ID Number Mocksville : NC 2742$ Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: t ant: Built Green Ind FAddress: wner: Luke Phelps ss: PO Box 1345 206 Tannin Way City: ._SalisburyY: Lexington ,;, State2iP: NC 28145 -:State/Zip: NC 27295 =Phone#: (704)202-1540 Phone#: (336)408-2048 :^ Property Location & Site information Address/Road#: Subdivision: Phase: Lot: Rocking Chair Lane Mocksville NC 27028 Directions St ructure SINGLE FAMILY Hwy 64 West to Sheffield Road toward end right on - _ Sheffield Farm Trail. Turn Rocking Chair Lane site on #_ofBedrooms: =q _ Right #of People: *Water Supply: PUBLIC *IP Issued by 2140 Natwns,Robert *System Classification/Description: TYPE 111 G.OTHER NON-CONN.TRENCH SYSTEMS *CA issued by: 2140•Nations,Robert SaproliteSystem? OYes ONo Design Flow: - 4 8 0 *Oi GRAVITY-SERIAL Pump Required? stnbution Type: O Yes QNo Soil Application Rate: 0 - 3 *Pre Treatment: Drain field Nitrification Field 1 '6 ' 0 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD No. Drain Lines 3 Installer: Randy Miller Total Trench Length: 4 0 0 8• Certification#: 1128 Trench Spacing: 9 Inches O.C. Feet O.C. *EHS: 2310-Debra Harmon Trench Width: _ 3 Inches Feet Date: 1 0 / .1 7 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 4 �ApprovalStatus` Inches Maximum Trench Depth: 3 6 inches ®:Approved O Disapproved Maximum Soil Cover; 2 4 Inches ' 220019 - 1 � 'c�IjFile Number.. County ID Number: 4891924804 Electric Equipment NEMA4XBox orEquivalent El Yes ❑ No Installer Box 12 inches Above Grade E) yes El 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 ❑ N o Apprnvat Status - ❑ Approvetl❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140-Nations.Robert *Qperation Permit completed by: op .Authorized State Ag Date of Issue: ____.,QwnerlApplicantSignature: -This"system has-been installed:in:compliance with applicable NC General Statutes:Article 11,Chapter 130A, Rules'for Sewage Treatment and Disposal, 15ANCAC_18A A900 et. Seq.,and all conditions of the Improvement Permit and; Construction Authorization.-This property is served by a NpE nil G. sewage septic system. RuleA 961 requires that a Type rn'E Ill G. septic system meet the following criteria: -- Minimum._System_Review ByThe Local Health Department: NIA w . Management_Entity: OWNER Minimum-System Inspection/Maintenance F req ue ncy By C ertified 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... x--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 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 by a public or private management entity,unless the system ownerand certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as tong as the system is in use,and other requirements for the continued proper performance of the system. It shalt also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing 01mport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 220019- 1 Davie County Health Department CDP'Fife Number: 210 Hospital Street 4891924804 P.O.Box 848 County File Number: Mocksville NC 27028 Date: O inch Drawing DrawingyType: Operation Permit Scale: , ONlockOLAL— ft. 4. ~ _ ra - `7 CIL d 4r, t . C. - GO V -gid _ CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 220019- 1 su_ Davie Count Health De artment 4891924804 Y P Cotanty ID Number.210 Hospital Street Evaluated For: NEW P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 6 / 3 0 / 2 0 x 1 Applicant: Built Green Ind Property Owner: Luke Phelps Address: PO Box 1345 Address: 206 Tannin Way City: Salisbury City: Lexington State/Zip: -NC 28145 State/Zip: NC 27295 Phone#: �(704)202-1540 Phone#: (336)408-2048 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Rocking Chair Lane Mocksville NC 27028 Directions 77 Hwy 64 West to Sheffield Road toward end right on Structure.: SINGLE FAMILY Sheffield Farm Trail. Turn Rocking Chair Lane site on #of Bedrooms: 4 Right #of People: *Water Supply: PUBLIC System Specifications - Minimum Trench Depth: a 4 (Saprolite Classification: Provisionally suitable Inches Minimum Soil Cover: System? O Yes ,(9 No 1 Inches Design Flow: 4- 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE II A.C_ONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field 1 6 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 3 1-Piece: OYes ONo Total Trench Length: 4 0 0 ft. GPM--vs— ft. TDH Trench Spacing: O Inches O.C. _ g ®Feet O.C. Dosing Volume: Gallons Trench Width: _ 3 OInches ® AFeet Grease Trap: Gallons inches Pre-Treatment: O NSF OTS-1 OTS-II Aggregate Depth: Septic Tank Installer Grade Level Required: 01011 OIII 01V Page 1 of 3 R CDP File Number 220019 - 1 County ID Number: 4891924804 • ' �. `� ❑ Open Pump System Sheet Repair System Required:®Yes ONO ONO, but has Available Space CDesign System Trench Spacing: Q Inches 0. . fication: Provisionally suitable — 9 ®Feet O.C. Trench Width: 3 O Inches w: 4, 8 0 — ®Feet Soil Application Rate: 0 3 a Aggregate Depth:5 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: 1 a LESS) Inches - Maximum Trench Depth: _ *Proposed System: 25%REDUCTION 3 6 Inches Maximum Soil Cover: a 4 _ Inches Nitrification Field 1 4 7 7 Sq.ft. *Distribution Type: GRAVITY-SERIAL No. Drain Lines 3 Total Trench Length: 3 6 9 ft. Pump Required: OYes ®No Q 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. Remi s 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. R mfg 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(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 O No Applicant/Legal Reps. Signature* Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 6 3 0 x 0 1 6 Authorized State Agent: Malfunction Log OYeS ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2of3 s CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street 4891924804 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 06 / 30 / .2016 O Inch Drawing Drawing Type: Construction Authorization Scale: . O Block O N/A ................._..................._...... ... , .... _ ...... ... ..... I I �l G r '.._ I j I i ..................................:.............................. .............................................................cJ..........1.................,..................................:............. ......... .......... ........ ............... ...............1................................. I I C I I I , I , I !.................................................................. ................L............._................ ........ .............� .. .......f i i................. I I � ! � 1 1 .............:................................................ . . . ...... .... ..... .... ........ F .........- ............... .... ......... ... ............ �... t �.. ... ....... ............1.......... .... ......... ...... _ I ..................1 f i ! i --- � � I I I j ........................ ....�............ , ...._.. ...._......!_.............................. .................................. ..__..... ..... . .........�......... ........ ......... ....:. ...................... ....... .................:.......................... ....... �... . .I ..............I . ..�.............. .. ... . � . I .... ...I. ..:� - 4 �. ......... ......... ......... .... ........... . .. j ... . ............... .. . i � I I ...................... . r .......... I....::. 1. ; . . .......... ...... T ..... S I CQ i. ! i I .... I 4 ............... ..................................... ........ ............. ...................................... ..._.......'... .........i... ... .._....i +. .. i................ ......... i................. ...... _ .... ! I I 1 � � I I � I i I ........................I.......................;.................. ......... .............. . L 1.............. ...........: .......................__....._........................................... . �................ 1 I 1 _ _� ... .... .. I I T ..... ...............I ..................... ...................... ............... ..... ..... ... .. 1.... ............:1..... .................._............ ............_. ..........................................._......... .., , j .......... . ............ ....... ..... ..... i . I } , 1...... ....... .�._........�.....:...._ I l. .. . i ................ ............._ ... .. ...... ..... ...... .... ....._.. ...... I.... .. ........ l ..... ! I ... ',.:..... ...... ........ ................. .......... .. i. .... ..... ... ................. i I j .. ! i .. .. . l i ................ .. .....a : ..... -- ........ i ! I I � I � �.. j i � L c i i i. i .. .. ..... I ................_ .... i _ � I I I jI � .................o ..i ._ ......i........... ..... ... I ......: :: _ .... :G:::: ::�::.. � w L.... ..... ..... ....... - ......... .... i P.1. ... .....P2 Page 3 of 3 i CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: P.O.Box 848 4891924804 Mocksville NC 27028 County File Number: Date: A6./.3.0 /..10 1.6. Click below to import an image from an external location: Drawing Type: Construction Authorization f i n4 t L-kI� �c 1 m Page 3 of P1 P2 For Office Use Only -IMP"ROVEMENT PERMIT *CDP File Number 22001 1 9-1 :. Davie County Health Department 210 Hospital Street County IDN umber.4891924804 P.O. Box 848 Evaluated For NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 6/30/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: Built Green Ind Property owner. Luke Phelps Address: PO Box 1345 Address: 206 Tannin Way City: Salisbury City: Lexington State/Zip: NC 28145 State/Zip: NC 27295 Phone#: (704)202-1540 Phone#: (336)408-2048 Propertk Location & Site Information Address/Road#: Subdivision: Phase: Lot: Rocking Chair Lane Mocksville NC 27028 Directions Structure:_ SINGLE FAMILY Hwy 64 West to Sheffield Road toward end right on of Bedrooms: 4 Sheffield Farm Trail. Turn Rocking Chair Lane site on #of People: Right 'Water Supply: PUBLIC System Specifications nitial System "S ite�`lassitication: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? QYes Q No Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 _ 3 1-Piece: QYes QNo 'System Classification/Description: Pump Required: QYes (D No OMay Be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) 'Proposed System: 25%REDUCTION 1-PteCe: QYes QNO Repair System Required:QYes ONO ONo, but has Available Space Repair System *Site Classification: Provisionally suitable Minimum Trench Depth: a 4 Inches Soil Application Rate: 0 3 2 5 Maximum Trench Depth: 3 6 Inches u - "System Classification/Description: Pump Required: QYes Q No Q May be Required TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) =Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 220019 - 1 County ID Numbef. 4891924804 *Site Modifications ❑ Open Fill Sheet 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. Site Plan The Improvement Permit shag be valid for 5years from date of Issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shag be valid without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drawn to a scale of one inch equals no more than 60 feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that Is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit Is subject to revocation if the site plan,plat,or intended use changes(NCOS 130A335(f)).The person owning orcontrolling 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 ONO Applicant/Legal Reps. Signature; Date: "issued By: 2140-Nations,Robert Date of Issue: 0 6 / 3 0 / a 0 1 6 Authorized State Agent. OValid without Expiration? O Create CA? @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department CDP File Number: 220019 - 1 210 Hospital Street 4891924804 P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: pBlock QN/A = ft, -Ar, L/� I � I z.O I I --- rl;77 s I � � IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street CDP File Number: 220019 - 1 P.O.Box 840 4891924804 Mocksville NC 27028 County File Number: Date: .0 6 1 3 0 1 2 0 1 6 Click below to Import an Image from an external location:Drawing Type: Improvement Permit • , �( �! ! /V d6 lwe 06-& APPLICATION FOR SITE EVALUATION/MTROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 848/2I0 Hospital Street Mocksville,NC 27028 fly' (336)753-67801 Fax(336)753-1680 Application For: 0 Site aluation/Improvement Pemut 0 Authorization To Construct(ATC) otlt Type of Application:�w System ORepair to Existing System OExpansion/Modification of Existing System or Facility ***IA9ORTWM**THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION 1S PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed )c l7reen Lit C— Contact Person &U Ck �I� Billing Address Home Phone "7D q ZpZ 1 5"q() City/State/ZIP 4L1,5[3 U-n! lie V 1 Business Phone !-70.q 214215. o06 Name on Permit/ATC if Different than Above 6 ,r 5 MailingAddress20 r4 ApJ&Y City/State/Zip W1166 J)C ZI PROPERTY INFORMATION: *Date House/Facili Corners Flamm ed N3 -0wuer's ermt O he cation Included: SitePlan`OPlat(toscale ( is valid Psite r j>!?<montlu with site plan,no exprtation with complete plat.) "33� Permit p NOTE:'A survey plat or site/plan must accompany this application. rd fo Phone Number Owner's Address 2-0te IA- ma W&J City/Stateaipb�4ifofm NC d 75 Property Address j City LotSiie i TaxPIN# !yPr,6 tlar[ tglgzq%OL' Subdivision Name(if a tcabl -r Section/Lot# Directions T Site: t 'iz'1 t0 t al 0A $ t If the answer to any of the following questions is'yes",supporting doeumentatioy must be attached. Are there any existing wastewater systems on the site? Dyes pfil Does the site contain jurisdictional wetlands? Dyes Are there any easements or right-of-ways on the site? OYes is the site subject to approval by another public agency? Oyes Will wastewater other than domestic sewage be generated? OYes o IF RESIDENCE FILL OUT THE BOX BELOW #People" ` - #Bedrooms !t #Bathroom!IK VJL -'Garden Tub/Whirlpool OYes ONo' Basement. es ONo Basement Plumbing:-Aes ONo j lj.z IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People ' #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:VeC.nventional Acceptcd'❑Innovative OAltemative OOther r.' Water Su.. pply Type:0 CountylCiry Water New WeII ❑Existing Well 0 Convnunity Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 Yes No• If yes,what type? i This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand y! that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Represenp4i.ye of the Dav' County HealthDepartment to conduct necessary inspections to determine compliance with applicable laws MvrAes. I rst nd that1afi re Biblefortloper idegli§Fation and labeling of property lines and corners and locati ort hou I' Inca or p nosed. I)I jon and the location of any other amenities _ �}�6� Site Revisit Charge Property owner's or owner's legal rep sentative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ONo Account# U00( 1 Revised 11/06 Invoice# l 4� N 491 1-qZ P, pose , SOFT Ic 3qLt A3 r 7:-� te 5S w rola` v ! i ...................._................._......__.....---.._...__..._....__._........------ ... _..._.._._.._._...--.._.__.._......._. .. PUT BOOK PACE' SIIRA.YOWS CERIiNwTG PN:4891921604 `IA611c LUKE ORNIYLLE PrEURS 9 CRVD E.RnGK•GVRY );MS PUT MAS DAMN 41OEA W fIPE11YB011 FROM NI ILTYL SLIMY MADE I11NOt W 9iERNAON town K9GDIId1 IIECUNfD N \ LOCK_PACE_EAIE 1,WT DIE BD I YMT Nor 9AIEYFD ARE CLEARLY NDICATED AS DRAWN FRO4 NFORIMTON N BDDK�PAGE w W THE - SHEFFIELD \ LI1C'Y P.PHELPS MOD O PRECrsK,N M CALQRATFD rs 1:10DODF 1 iMT TNS PIAT BIAS PREPARED N ACLVMVECE IKN D5.47-30 M MENDED. e FARMS TRAIL / \_ D.a 950 PC.445 M 4rP 6 A SURAT CLF M DMINO PNICEL OR PARMS OF UNO AND Das Na CAFAE A NEW SARM OR OANGE M DMNC VFW. (PRIVATE) N/ N_ '47.45 ACFIEs(REMAIN") aT11Ess W ORIaAL 111040UME•Raa9MTNNSEAL TI4s ITN wr a 1Mr,tots wD.�Mowualrt'M 2• .,�y. lawl sro S ,2s 6 VEKE LYNN iflEELLW D.a 794 PD u6 / -/4„` aRAInDRF134X0s NEammvm I Ste''�j ) REasIMrlDn NweER 9o.sg S ` . /�/ f SBRM L3469 J1 Pw:1eNe3%,. 7s2{0• SITE -�5 rtN�0: JDNiNE mLCDODsxcrs 1j32.37 .E i Ra S. 8-oumlOm Dal8B m MAI %PD167 W7s4G� / DRANRORa PE8E11YEG 754' L ae91 ssPD 701SIM3 y�/ AWES DADAVIDM xl _ e LOT 1 PROPOSED S n VICINITY MAP 6.11 ACRES YARD lOe.sr N - 7ti 2,000' b \. \ 6 DAEY F.GOIT PFRIRT-ENEw CHERYL I ,y.ZSh A CORT D.L aee PG.422 OR)w Y6 N1 g STAAM OF NA ODUN �N�RWA 4eNelaOn \� \ PROPOsm . . L 11�y/U M l — REVIEW ONK:u AVE CLF CLLou6r. uK.ruE1 A REYxDws /\/jam\\ I NousE- cERIEY RIVE—OR oR PuTOr wNOI TNa cEATFrwml B. _ R. B Ii7DaD PEERS MSfAMOR1' i0R RECMiDNw S 89.59.18•M A REVIEW, 818.90 TOT 138.29 >• S Pro ae919O19J7 \`(\�O NN ae9191e6xx / / 9 OTE /-/ olli mflOBFAfEwwA LEEEYAS /X\\\"ty u °P H Ian:469nzae7/ 1 I l R I FILED zo. Y"EKY°�A"E THAT.ro THE Bes7 a W mawEDCG na D8 6,0 VMS \\4y, DH 9e0 P4 at BOBBT KNKi1f , I 'yM" 2.76 09:52 J1rt1 MON-SRNE 1MNfNlFD RMD(S)N10Rm UtOflf/1154.ID Fn61Ncm \ \ MARGARET S.KNIGHT n� / DAME COUNTY NC nNOItcN/s..47 a Ira couArc s11e0rASIa1 REGuuTR,N4 AN! xawaaOSNE Fw7aWx1A \ \ D.B.193 PG.120 I / / BOOK O9.T2 (NMELL BEBDLiiro'r`SiRE MA BEEN"RED r` '� PAGE wa6 U.BRENT SHOAF ALSO HOREW 01 CL TMT DACE THE RDLNpr(rsD)�rs�coNNwclm //,n` To rHE REGWED srAADoss.R wKL stREESi( ) NwnoR"I`MOa sERUEO \\��QP7, , I _ / REGISTER OF DEEDS RESPOASNLE Fm 4NNrvwACE O 1e9t9ox%a INSTt 02430. //--cNKs Y o If P a�G PIN:4891924804 LUKE GRANVILLE PHELPS �lbh j� Y HEREBY CERTIFY THAT 7NE SUBDIVISION NAT 9KNR1 HEREON LUCY P. PHELPS / n81EEN RE—n WITH na iDDADTO EDE CEP °M Y IN Y.aANCE%s w. D.B.950 PG. 445 = / AS ARE HOED N THE uNUYC;OF WE PI—K,BOARD Aro 47.45 ACRES(REMAINDER) - IF / THAT rt MS BEEN APPRD.ED FOR RE—N HE OFFICE OF / THE OY&FOR O aEDs. rt rs SWT MANN TMr OVAIL APPRDYN FOR RECORwR,DN oas NDS NOR D SIT L INCLUDE / l / NsrAu Aro R.,SAFAC OR NOR DOES rt BAN /F l l I / / j ArPRwAE FOR�rra C.N.nOR occwMn O elRw<s M06Eg3¢U6NE ,\ D.B. RwRi,o('(CLRDS L01-R +'` cRAAroR6NDRFsmEmm~�\ i I D.e�asR�vc:Ru'"s. A. I haat DAVE CaNry w.r«Nc DEP.ARUENr OIF.Ngo vc.«e 1>\� RTE nAN�avAR r OF DAVIEE N Y I\ /// V`>E S I /`'�/ NDroRTA nRaKW nRE aV DEwnPlrulr oROINN / 9 \ � PIN seDlO0x7oO i ``5 I / / % mAOOEs6 PIANNNG DICE oR J L La1ER PIN: W91520475 �I / / FASFNEMr // JU1VM L YILLER D.S.622 PF 210 511 DANNY CCORD NNELLI I FyNNOm / ♦ //`/'['\ D.B.199 PG 813 1 I DRMr 9L mts / I THE DFASIOA OF HIM NAAAM AS NtOYOED IRE A w MC GOF m µm /M LEGEND (G). SEND 61fAED DATE K.DWECTOR �seo,AIOOD.x3.s / ONINiPE P00.oll=PG. 010,00,`, FINAL PLAT FOR NN 16N9oJ251 //�'R' OB°56FACIE MPG 6°6 DebK. , /�4� �� _� ;/ DAPMIE UED6YCOOROIFMEI 0D. PHELPS PROPERTY /,.07 / / 7ws wPls slNJECT TOANYAIOALLEASENEMT, OWNER/DEVELOPER: MOILFI1CLLrsNE ///v ``\ I I N 513'51.513'E / / AGREEMENTS MORT*HTS OF MY OF RECORD NN NOT �\ V16BLE ORAPPAREW ATTHE TIE OF NSPFCTIOH. LUKE GRANVPHE PHELPS Fusnam \ // ,7 1 I f08.{9•CM 2 LUCY P.PHELPS OKNDOK1 Af9N1Vro \]/.(,/y PR 68DDD92989 I 100.00'R , / 711E SURVEYOR HAS NOT PERFORMED A TITLE INVESTIGATION 20I TANNIN WAY UeFMFN 77 �O L ULA / / ONMISPROPERW., REFORE,TNSL MStRXCTTOMY L�INGTON.NC 27295 JUDY A USE I ) 5 68.16.55'E / / ANDMLFACTSMACCURAW1 IVVESTIGATgNMAY / OA 3x9 PG 719 162.29• \ DAVIE/ TOWNSHIP:GLMKSVILLE COUNTY DDNORTH CAROLINA M18 KDEED O , OBURwSCALE:1• 100• DATE: 05-17-20 16 PERFORMED BY FLEMIWG ENGINEERING,PAC, KM 0 N 1N ri a1IF %uLTCHtw� ,� NROPERrr IS N HLAVI9Ki caEEK WATERSHED.WSJR PN:5110,002144 EASEMENT EXTENSION FROM / REBENCG-EENAHN KNNLL LUKE G. PHELPS PROPERTY CO""EA L 1 FUS1N0m -_ I _ — / D.e.eee RPa 00, TO SHEFFIELD RD. (S.R. 1306) I wNRNrD i NN:4891817813 1 Fleming Engineering Inc. I 1 PN:4/391911726 4 PIN:{°9161x277 I 1 FJusrwcm JMES DAVID MARSHALL i FFI S I�(DKAN O.B.655 PG.701 I SYDNEY F.GOTT' CONSULTING FNGINFPF56 LWDSURVEYORS li SCALE:1• 200• VEYOE LYNN FREEMAN 1 D.B.794 PG.678 CHERYL A GATT IFR L na NFFaw D.B.e66 Pc.422 8518 Triad Drive Colfax NC 27235 / 0 1N w6 I I Phone(336)852-9797 license No.C-0950 ROCKING CHAIR LANE(PRIVATE) www.FlemingEngineering.com PROJ.NO.16001.001 DRG PAM PRO/16001-001/DRG/16001-DOL Phl%AA PID 9 DMwn W:L54 RECEIVED r a3�I APPLICATION FOR PRIVATE WELL PERMIT lata V/ Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(3367751-8786 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION l Name to be Billed U incl Contact Person �t V� 0 LS Billing Address P.Q. Home Phone 7/)Q ZI to Scon ity/State/ZIP ( Business Phone 2Dq -71 tl S 33$ Email a) COM railing me on Permit if Differen than Above 5 Address 20 — City/State/Zi i C PROPERTY INFORMATION *Date House/Facility Corners Flagged OTE: A survey Tat or site plan must accompany this application. Included: Site Platt)Plat (to scale) Owner's Name Ls&c NA 1) S ' one Number336 40A X 46 Owner's Address *2 At City/State/Zip �.Cl►'li�+t Y?C ��7��9 Property Address City Lot Size /krts Tax PIN# Subdivision Name(if applicable} Section/Lot# Directions To Site: 7fZ or V' t 1 an t-d FAtIA mut, DEVELOPMENT INFO TION Permit Type: New Well ell Repair Well Abandonment Other(specify) Facility Type:e: ResidentialFood Service Church Cot ercial Other re There Any Septic Systems Currently On The Site? YES NO V" Do You Intend To Install A New Septic System On This Sit . IES NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions,the specific location of the facility and any existing or future appurtenances,the location of any existing septic system,sewer lines,water lines,any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application,the applicant signifies that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. signed Date Site Revisit Charge Date(s): Tient Notification Date: HS: i i aoocg7/30/09 Account# i Invoice "" APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 848/21.0 Hospital Street Mocksville,NC 27028 (336)753-67801 Fax(336)753-1680 Application For: O 5ile aluation/Improvement Permit 0 Authorization To Construct(ATC) Toth Type of Application: . ew System ❑Repair to Existing System OExpansion/Modification of Existing System or Facility *01AVORTAMP"THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION I_ Name to be Billedsv I O rt'en Contact Person 134C IJ Billing Address a. F nj I Home Phone —7nq 7p'z j 5 qO City/State/ZIPS/ILt y G j G 'AIZ14E Business Phone "70!d 2/& 5. :pQ d Name on Permit/ATC if Different than Above LLS ,E 5 Mailing Address d N INJAY, City/State/Zi PROPERTY INFORMATION *Date House/FaciV Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included:IWSite Plan OPlat(to scale (Permit is valid for fAmonths with site plan,no expiration with complete plat.) 33�,40 g_2O�9 owner's Name V l 2 Phone Number 6 Owner's Address,? fe OA nttN U//l'') City/Stateaip Property Address City Lot SizeTax PIN# WRC5 P411A $OIICIZ—LNOL1 Subdivision Name(if�apA icabl Section/Lot# {Directions To-_Site: ( C a�fi0 telt do f� f• O/1 5 t If the answer to any of the following questions is"yes",supporting documentatioy must be attached. Are there any existing wastewater systems on the site? Dyes i0o Does the site contain jurisdictional wetlands? DyesAre there any easements or right-of-ways on the site? Oyes Is the site subject to approval by another public agency? OyesWill wastewater other than domestic sewage be generated? ❑Yes IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms -t #Bathrooms /d. -_- Garden Tub/Whirlpool❑Yes ONo ii Basement: es ONo Basement Plumbing:LRI'es ONO 3 a V;& IF NON-RESIDENCE FILL OUT THE BOX BELOW Type ofFacilityBusiness Total Square Footage of Building_#People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:• Conventional Accepted Olnnovative OAlternative OO.ther Water Supply Type:O County/City Water VNv,Well OExisting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?O Yes No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Represen 've of the Davie County Heap Department to conduct necessary inspections to determine compliance with applicable laws an es. Irst nd that 1 amh re Bible fort oper ideal{ljeation and labeling of property]fines and comers and locati a or hou 1 o �� Ill on and the location of any other amenities �Uf Site Revisit Charge Property owner's or owner's legal rep sentative signature Date(s): 14 lox]! wZ11t, Client Notification Date: Date EHS: Sign given OYes ONo Account# Revised I1/06 Invoice# NCDENR - Division of Environmental Health On-Site Wastewater Section 'ADate: e s / s l a e i 6 Soil/Site Evaluation *File#: 2 a e e 1 9 For On-Site Wastewater System PIN #: 4891924804 "Owner Luke Phelps Proposed Facility SINGLE FAMILY Proposed Design Flow(.1949) Location of Site Rocking Chair Lane Property Size 6.11 WaterSupply PUBLIC Evaluation Method n!a P.4— 1�940 Horizon SOIL MORPHOLOGY Profile# Lan scape •Depth .1941 Other Profile Slope% (IN), Mineralogy Matrix Mottle Factors f _ Texture Structure Consistence Color Color L lam• t�f '' �((J J G / / P�:f .1942 Wet. r ' —�i\ G G C .1943 Depth GPS Sap(olke:On) .1944.Rest. Horizon EHS .1947 Class Proflle LTAR_, • 3 c> 3 C .1932 Wet. .0 1943 Depth GPS Saprolite:pn) .1944 Rest. Horizon EHS 1L947 Class file LTAR© 'opVT ' . .a.._ .1942 Wet. °!o .1943 Depth GPS Saprolite:pn) .1944 Rest. Horizon EHS 1947 Class Copy rofle Poll LTAR,_. .1942 Wet. ,1943 Depth GPS Saprolite:00 .1944 Rest. Horizon EHS .1947 Class Copy rorile Profile AR .1942 Wet. .1943 Depth GPS Saprolite:CN .1944 Rest. Horton EHS .1947 Class Copy ofile Profile LTAR" Available Space(.1945) Other Factors(.1946) Ste Classification (.1948) Initial LTAR: V- � Repair LTAR: Others Present: Comments: Evaluated By. Nations,Robert NCDENR Division of Environmental Health On-Site Wastewater Section Date: © 6 / a 9 / t3 1 s Soil/Site Evaluation Fie#: 2200 19 For On-Site Wastewater System PIN #: 4 8 9 1 9 2 4 s a 4 14940 Horizon SOIL MORPHOLOGY Lan scape .1941 OtherProfile Profile# POS Depth Factors Sipe% (IN) Mineralogy Matrix Mottle Texture Structure Consistence Color Color .1942 Wet % .1943 Depth GPS Saprolde:pn) 1944 Rest. Horizon .1947 Class ENS CopY.-Protil ProflleLTAR" • . .1942 Wet % .1943 Depth GPS Saprolitcon) .1944 Rest. Horizon .1947 Class Copy -EroEHS rd Pro 'e�) LTAR— .1942 Wet. % 1943 Depth GPS Saprolite:00 .1944 Rest. Horton .1947 Class EHS Proflle Copy roll ILTAR�, • . .1942 Wet % .1943 Depth GPS Saprolde:(h) .1944 Rest. Horizon EHS .1947 Class copy. rotil LTARProflle .1942 Wet % .1943 Depth GPS Saprolde:(in) AHo tzonst. EHS .1947 Class CORY-.tufa Profile U LTAR Comments: . Attach Image The "Open Drawing Form"button, opens the the drawing form. The "Import"button, attaches the drawing,or other image Into the space below. # Open Drawing Farm Profile: X . _ Y Z Profile: X Y Z Profile: X Y 2 Profile: X Y Z Profile: X-- Y Z Profile: I@ X Y Z - . Profile: X-, Y Z Profile: X Y Z Profile: l@ X Y Z Profile: 0 X Y Z Well Construction Permit For office use Only Davie County Health Department "COP File Number 220019 r � 210 Hospital Street PIN Number 4891924804 P.O. Box 848 Mocksville NC 27028 Tax Lot#: Tax Block#: Phone:336-753-6780 Fax:336-753-1680 Evaluated For: WELL PERMIT VALID UNTIL: 6/29/2021 PropertyOwner. Luke Phelps Applicant: Built Homes Inc. Address: 206 Vannin Way Address: PO Box 1345 City: Lexington City: Salisbury StaterLip: NC 27295 State2ip: NC 28145 Phone#: (336)408-2048 Phone#: (704)216-5000 Property Location & Site Information rddress/Road#: Subdivision: Phase: Lot: Chair Lane *Proposed use of Well: le NC 27028 If Other: Latitude Longitude Directions Site Address: Rocking Chair Lane Directions: Hwy 64 West to Sheffield Road toward end right on Sheffield Farm Trail.Tum Rocking Chair Lane site on Right Well Contractor Information Drilling Contractor Driller Registration fit I If Permit Conditions 'Permit Conditions Well location.construction and protection must meet all state and local regulations and must be Inspected and approved by an authorized representative of the Local Health Department.The permit may be revoked at any time for failure to complywith existing regulations.The siting of approved well construction area(s)by the Health Department Is to provide protection from the known possible sources of contamination.The approved well area(s)may not be changed without written permission from an authorized representative of the Local Health Department.No volume of quality of water is guaranteed by the Health Department. *Issued By: 2140-Nations, Robe *Date of Issue; 0 , 6 / a 9 / 2 0 1 6 Authorized State Agent &Hand Drawing Olmport Drawing Owner/ApplicantSignature: **Site Plan/Drawing attached.** WELL.CONSTRUCTION PERMIT220019 Davie County Health Department CDP File Number: 210 Hospital Street 4891924804 P.O. Box 848 County File Number. Mocksville NC 27028 Date: 0 6 / 2 9 / 2 0 1 5 awl 0Inch Drawing Type: Well Permit Scale: , Q Ack _ ` ,� U ft. ----------- QIZI I I I I I I I � I I I I I I l I i •J CONSTRUCTION For office Use Onlv AUTHORIZATION *CDP File Number 220019-1 °= Davie County Health Department County ID Number:4891924804 It 210 Hospital Street Evaluated For NEW P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax: 336-753-1680 0 6 / 3 0 / a 0 a 1 Applicant: Built Green Ind Property Owner: Luke Phelps Address: PO Box 1345 Address: 206 Tannin Way .City: Salisbury City: Lexington State0p: NC 28145 State/Zip: NC 27295 Phone#: (704)202-1540 Phone#: (336)408-2048 Property Location & Site Information r dress/Road M Subdivision: Phase: Lot: ocking Chair Lane ocksville NC 27028 Directions Hwy 64 West to Sheffield Road toward end right on Stricture: SINGLE FAMILY Sheffield Farm Trail. Tum Rocking Chair Lane site on #of Bedrooms: 4 Right #of People: 'Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 Site Classification: Provision ally Suitable Inches Saprolite System? OYes Flo Minimum Soil Cover. 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover. 2 4 Inches 'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons 'Proposed System: 25%u REDUCTION 1-Piece: OYes @No Pump Required: OYes @No OMay Be Required Nitrification Field 1 6 0 0 Sq ft Pump Tank: Gallons No. Drain Lines 3 1-Piece: OYes ONo Total Trench Length: 4 0 0 ft GPM vs— ft. TDH Trench Spacing: _ 9 Weetnches C.0 Dosing Volume: Gallons Trench Width: _ 3 C)Fe (E)Feet Grease Trap:- Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-11 17 Septic Tank Installer Grade Level Required: OI OII 0111 OIV Donn 1 of 4 CDP File Number 220019 - 1 County ID Number. 4891924804 ❑ Open Pump System Sheet Repair System Required:@YeS ONO ONO, but has Available Space rDesign System Trench Spacing: 9 QInches O.C. ification: Provisionally Suitable — tJ Feet O.C. Trench Width. QInches w: 4 8 0 _ 3 . @ Feet Aggregate Depth: Soil Application Rate: 0 3 a 5 inches Minimum Trench Depth: a 4 Inches *System Classification/Description: TYPE II A-CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS), Minimum Soil Cover. 1 a Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 3 1 4 � � Sq.ft. Inches No. Drain Lines *Distribution Type: GRAVITY-SERIAL -Total Trench Length: 3 6 9 Pump Required: Oyes @No C7Mey Be Required Pre Treatment: ONSF 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 bythe Health Department in no wayguarantees 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 bevalid for a person equal to the period of validity of the Improvement Pernit,not to exceed five years,and may be issued atthe sametime 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 forassuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicari t.egal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date:_ 2140-Nations,Robert 0 6 / 3 0 / x 0 1 6 *Issued By: Date of Issue: . _ . Authorized State Agent: Malfunction Log OYeS @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 1 s CONSTRUCTION AUTHORIZATION Davie Cobnty Health Department CDP File Number: 210 Hospital Street 4891924804 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 6 / 3 0 / 2 0 16 Q Inch Drawilni! Drawing Type: Construction Authorization Scale: . Qslock Q N!A EN I # 1 ( ZZ --il\i-N # �Q I # # E CONSTRUCTION AUTHORIZATION - Davie County Health Department 210 Hospital street CDP File Number: P.O.Box 848 4891924804 Mocksville NC 27028 County File Number: Date: .0 .6 / 3 0 / 2 0 1 6 Click below to import an Image from an external location: Drawing Type:Construction Authorization