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2087 Hwy 801NCSPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336.753-1680 Applicant: Joe Helton Address: 1418 Primrose Lane City: Franklin State/Zip: TN 37064 Phone #: (615) 430-7778 Property Owner. Joe Helton Address: 1418 Primrose Lane City: Franklin StatefLip: TN 37064 Phone #: (615) 430-7778 y Proaerty Location & Site Information Address/Road #: Subdivision: Phase: Lot: 2087 NC Hwy 801 N Mocksville NC 27028 Directions Inches Hwy 601 North right on Hwy 801, be on the right past structure: SINGLE FAMILY Cedar Forest Lane # of Bedrooms: 3 Inches # of People: ®: Approved 0 Disapprove 'Water supply: PUBLIC 6 *IP IPby. 'System Classification/Description: _ -- TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140 -Nations, Robert Saprolite System? QYes (No Design Flow: 3 6 0 Distribution Type: NIA Pump Required? QYes QNo Soil Application Rate: 0 a *Pre -Treatment: Drain field Nitrification Field 1 8 0 0 Sq. It. *System Type: INFILTRATOR OUICK 4 STANDARD No. Drain Lines a Installer: Randy Miller Total Trench Length: 4 5 0 Certification #: 1128 Trench Spacing: 9 Inches O.C. Feet O.C. *EH S: 2140 -Nations. Robert Trench Width: 3 Inches &Feet Date: 0 4/ 2 1 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 4Approvat Inches Zak Status" Maximum Trench Depth: 4 8 Inches ®: Approved 0 Disapprove Maximum Soil Cover: 3 6 Inches CDP File Number 201758 • 1 Manufacturer. STB: Gallons: Manufacturer. Date: Installer. PT: *Filter Brand: Certification #: Gallons: ST Marker. ❑ Yes ❑ No nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Counter ID Number: . )tic TanK Lat. Long: Installer Certification #: 'EH S: Date: Pump Tank Manufacturer. Installer. PT: Certification #: Gallons: *BHS: Date: Date: RiserSealed ❑ Yes ❑ No RiserNeight: ❑ Yes ❑ No (Min.6 in.) Approval Status Reinforced Tank: -0 Yes ❑ Na ❑Approved ❑ ; Disa roved 1 Piece Tank: El Yes ❑ No �Pp Supply Line Pipe Size: inch diameter Installer; Pipe Length: feet Certification #; THS: *Schedule: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status © Approve, d❑=;Dlsappravetl:-.' Pump Requirement Pump Type: Installer. Dosing Volume: — Gal Certification #: Draw Down: Inches *EHS. 'Chau: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ No Approval Sfatus PVC unions El Yes ❑ No ❑ Approved sa-pproved= Vent Hole ❑ Yes ❑ No Anti -siphon Hole El Yes 0 No CDP File Number 201758 -1 NEMA 4X Box or Equivalent ❑ Yes Box 12 inches Above Grade ❑ Yes Box Adj. To Pump Tank ❑ Yes Conduit Sealed ❑ Yes Pump Manually Operable ❑ Yes *Activation Method: Alarm Audible ❑ Yes Alarm Visible ❑ Yes *Operation Permit completed by. Authorized State Age County ID Number: eiecLnc Caurarneni ❑ No Installer. ❑ No Certification#: ❑ No ❑ No *EH S: ❑ No Date: ❑ No Approval Status Approved ❑ Disapproved' ❑ No -, fi 2140 - Nations, Robert Date of Issue: 0 4/ a 1/ a 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 as conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE u A sewage septic system. Rule .1961 requires that a Type TYPE II A septic system meet the following criteria: Minimum System Review ByThe Local Health Department: N/A Management Entity: OWNER __- .1 _-Minimum System Inspection/Maintenance Frequency By Certified Operator. NIA Reporting Frequency By Certified Operator N/A 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 forthe 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 entity with a certified operatorforthe 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 shalt also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.**` OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit CDP File Number: 201758-1 County File Number: 27028 Date: ! / Q Inch Scale: , OBlock ft O NIA i FT -1 III1 1-71 1 -1 1 CONSTRUCTION - " s AUTHORIZATION * % Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Joe Helton Address: 1418 Primrose Lane City: Franklin State/Zip: TN 37064 Phone #: (615) 430-7778 �ddress/Road #: - 2087 NC Hwy 801 N Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC Subdivision: ,*Site Classification: Provisionally Suitable Saprolite System? O Yes ®No Design Flow: 3 6 0 Soil Application Rate: 0 a *System Classification/Description: *Proposed System: Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: PERMIT VALID UNTIL: 0 3/ 1 4/.2 0 a 1 Property Owner: Joe Helton Address: 1418 Primrose Lane City: Franklin State/Zip: TN Phone #: (615) 430-7778 ion 37064 Phase: Lot: Directions Hwy 601 North right on Hwy 801, be on the right past Cedar Forest Lane ns Minimum Trench Depth: a 4\ Inches Minimum Soil Cover: 1 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: .2 4 Inches *Distribution Type: Septic Tank: Gallons 1 -Piece: O Yes O No Pump Required: O Yes O No O May Be Required 1 8 0 0 Sq. ft. Pump Tank: Gallons 5 1-Piece:OYes ONo 4 5 0 ft. GPM—vs— ft. TDH gO Inches O.C. ® Feet O.C. Dosing Volume: Gallons 3 Olnches ® Feet Grease Trap: Gallons inches Pre -Treatment: O NSF OTS -1 O TS -11 / Septic Tank Installer Grade Level Required: 01011 O 111 01V Page 1 of 3 CDP File Number 201758 - 1 County ID Number: ! ❑ Open Pump System Sheet Repair Svstem Required: 0 Yes ONO ONO. but has Available Space Trench Spacing: Inches O. Site Classification: 0 Feet O.C. Design Flow:**** 15A NCAC 1 **** 817etes Soil Application Rate: Aggregate Depth: inches *System Classification/DescriRe pair AreaExempt—Minimum Trench Depth: Inches Inches Maximum Trench Depth: *Proposed System: Inches Maximum Soil Cover: Nitrification Field Inches Sq. ft. No. Drain Lines Total Trench Length: ft. *Distribution Type: 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. Rw= n'' 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. 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 ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140 - Nations, Robert Date of Issue: 0 3 / 1 4 / 2 0 1 6 Authorized State Agent: Malfunction Log OYes ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 Chwadt s Remaining 2000 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 201758 - 1 County File Number: Date: 03 / 14/a016 O Inch Scale: O Block O N/A Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION L Davie County Health Department 210 Hospital Street CDP File Number: 201758 - 1 P.O. Box 848 Mocksville IVC 27028 County File Number: �G,,,,,g� ✓" ' ���-1/- q—ll—( Date: 03 /14 /.2.0.1.6. Click below to import an image from an external location: Drawing Type: Construction Authorization Page 3 of 3 P1 P2 CONSTRUCTION For office use only. AUTHORIZATION *CDP File Number 201758-1 Davie County Health Department County ID Number: ; 210 Hospital Street Evaluated For REPAIR .� �. P.O. Box 848 Township Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 3/ 1 4/ a 0 a 1 Applicant: Joe Helton Address: 1418 Primrose Lane City: Franklin State2ip: TN 37064 Phone #: (615) 430-7778 /Address/Road #: Subdivision: f 2087 NC Hwy 801 N Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: -Water supply: PUBLIC Property Owner: Joe Helton Address: 1418 Primrose Lane City: Franklin State2ip: TN 37064 Phone #: (615) 430-7778 Phase: Lot: Directions Hwy 601 North right on Hwy 801, be on the right past Cedar Forest Lane ons Dann I of Z Minimum Trench Depth: a 4 Inches Site Classification: Provisionally suitable Saprolite System? OYes @No Minimum Soil Cover. 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a Maximum Soil Cover. a 4 Inches *System Classification/Description: *Distribution Type: Septic Tank: _ Gallons *Proposed System: 1 -Piece: OYes ONo Pump Required: OYes ONo OMay Be Required Nitrification Field 1 8 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 5 1 -Piece: OYes ONo Total Trench Length: 4 5 0 ft GPM—vs— ft. TDH Trench Spacing: 9 QInches O.C. Feet O.C. Dosing Volume: _ g Gallons Trench Width: 3 Inches Feet — Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -II / Septic Tank Installer Grade Level Required: 01 011 0111 OIV l Dann I of Z CDP File Number 20175$ - 1 County ID Number. ❑ Open Pump System Sheet uireo:lJitrb %✓IVU VIVU,UtItlldbHVidlldUlt:0 Trench Spacing: Q Inches 0., Site Classification: 181-%.w"45 Feet O.C. Inches Design Flow**** 15A NCAC Fee Soil Application Depth:n Rate: inches Minimum Trench Depth: 'System ClassificationlDescriRepair Area �Inches Inches Maximum Trench Depth: *Proposed System: Inches Maximum Soil Cover. Nkrification Field Inches Sq. ft. No. Drain Lines 'Distribution Type: Total Trench Length: ft. Pump Required: OYes ONo OMay Be Required Pre Treatment: ONSF OTS -1 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 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 Perml% not to exceed five years, and Maybe 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 ONo Applicant/Legal Reps. Signature: Date: - / / *Issued By: 2140 -Nations, Robert Date of Issue:. 0 _ 3 / 1 4 / 2 0 1 6 Authorized State Agent: Malfunction Log Oyes f ,1 C Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number. 201758 -1 County File Number: Date: 03/14/2016 Q Inch Scale: QBlock QN/A M 0 M NINE MEN M 0 0 0mom NoHim 1 ME 11 CIN .. 0 mom mom 0 0 No ME mom mom 0 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksviile NC 27028 CDP File Number: 201758 -1 County File Number: Date: .0 3/ 1 4/2016 Click below to import an Image from an external location: Drawing Type: Construction Authorization • DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST IST u&sc11 APPLICATION IP/ATC OSWW REPAIR 3310-401 - 01'53 Name ,,�0-r— Re 14ori Telephone Number (g/S-1-130-7772' Address 2061 NC Nigh way got N Mailing Address (if different from above) 1q1% QPrimrast Gn franrl irr "r/4 3%0 (9y Email Address: Subdivision Name Lot # Directions Date System Installed Name System Installed Under Type Facility ReS Number Bedrooms 3 Number People Served 0.,, Type Water Supply uln Specific Problem Occurring qu►- ; /� At r au ' dt ar In a�,S-e, r 0445 ��- G e w Date R uested In Taken By 0. M;fz h-e, 1j V�Cih THIS IS IFY THAT THE INFORMATI N PROVI IS CORRECT TO THE B KNOWLEDGE, AND I AM SIBLE FOR G INC RRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason Revised 2-2011 1 NAME ri af'x^-t lq— ADDRESS U 90 l-1 DI TIONS TO r Z2 -LL . %hllla,- DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION` APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) G PHONE NUMBER - 7 SUBDIVISION NAME Glc S 1/ LOT # DATE SYSTEM INSTALLED 3 NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY W P- L( SPECIFY PROBLEM OCCURRING V✓ - SIV DATE REQUESTED .7 3JO L INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges Incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 ...f� * `�•t� ��w,� \-.; C:r .i$4 t'.•n � '��°iti X� � rx4"�-yy� r� i lie . Y �t _y_ ..r.,,, .,.•'_ �,N+M•r,,., .1 '::,:, A ,•Y'.n1.'rh�'' 1.... 4^� , / PerrtijtTee s ,✓� AVIE COUNTY HEALTH DEPART El� 7` t - • r * 'f +') ,;4`;',x'3 Environmental Health Section � PROPERTY INFORMATION tfaine: "j prop, 848 rty' G d� t' 1 �;W /r/ `M �k P.O. Box 27028 + . Subdivision Name: '5irection� toe �/ 3 Phone #: 336-751-8760 (" ri`' Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# -_ SYSTEM CONSTRUCTION AUTHORIZATION NO: 9 A Road Name: C �L ip:� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r �eJ r ✓ -" ***NOTICE***.THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FORA PERIOD OF FIVE YEARS. .ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS S,? # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPL ' DESIGN WASTEWATER FLOW (GPD)C9 NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH. ROCK DEPTHOI?,V LINEAR FT> OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT . % % 41 3 **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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT V SYSTEM INSTALLED BY:�� 4 AUTHORIZATION N OPERATION PERMIT BY:!l� DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE J WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02102 (Revised) Parcel #: C500000089 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: C500000089 Account #:8302258 Owner Information uiidin : Tax Codes BXF: ELTON KRISTA M nd: ADVLTAX - COUNTY TA arket• 1418 PRIMROSE LANE essed: FIREADVLTAX - FIRE TAX eferred• FRANKLIN, TN 37064 00927 0962 06 2013 WD Property Information Improved Township nd (Units/Type): 5.210 AC 00927 0966 FARMINGTON ddress: 2087 N NC HWY 801 Improved 0 Deed Information Local tonin Pate: 06/2013 Book: 00927 Page: 0962 Plat Book: Page: Le al Description PIN SAC HWY 801 5842969910 Property Values uiidin : 89,23 BXF: Improved nd: 65,59 arket• 154,82 essed: 154 82 eferred• 2 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00120 0295 08 1983 WD Unqualified Improved 0 2 00927 0962 06 2013 WD Unqualified Improved 0 3 00927 0966 06 2013 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bili Information « Return to Basic Search 0 Page 1 of 1 o�`.r� °t Davie County Web Site All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's Internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the Information set forth on this site whether express or Implied, In fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1458863 9/21/2016