6033 Hwy 801SM
I
. "R
OPERATION PERMIT
�wFs Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Byran Pollick
Address: 6033 NC Hwy 801 S
City: Mocksville
State/Zip: - NC 27028
Phone M (336) 480-7605
Property Loca
Address/Road M Subdivision:
6033 NC Hwy 801 S
Mocksville NC 27028
Structure: MOBILE HOME
# of Bedrooms: 4
# of People:
*Water Supply: PUBLIC
*IP Issued by:
*CA issued by: 2399 - Eldridge, Tiffany
Design Flow: 4 8 0
Soil Application Rate: 0 a
Nitrification Field
No. Drain Lines
Total Trench Length
Trench Spacing:
Trench Width:
Aggregate Depth:
Property Owner: Byran Pollick
Address: 6033 NC Hwy 801 S
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 480-7605
-
Phase: Lot:
Directions
Hwy 601 S. left on Hwy 801. On the right just before
Deadmon Road.
*System Classification/Description:
TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? O Yes {8 No
*Distribution Type: NSA Pump Required?
Oyes W No
*Pre -Treatment:
Drain field
a 4 0 0 Sq. ft.
5
600ft.
9 O Inches O.C.
® Feet O.C.
3 Q Inches
® Feet
inches
*System Type: INFILTRATOR QUICK 4 STANDARD
Installer: D Spencer Plumbing
Certification M 3440
*EHS: 2399 - Eldridge, Tiffany
Date: 0 6/ 1 7/ a 0 1 6
Minimum Trench Depth: a 4
Inches
Minimum Soil Cover: 1 aInches Approval Status
Maximum Trench Depth: 3 6 Inches ® Approved ❑ Disapproved
Maximum Soil Cover: a 4 Inches ,
Page 1 of 4
CDP File Number 218724 - 1
Countv ID Number:
Manufacturer:
Gallons:
Lat.
Date:
Draw Down:
Long:
Yes
STB:
No
Riser Height: ❑
Yes
❑
NO (Min. 6 in.)
Reinforced Tank: ❑
Gallons:
❑
NO
1 Piece Tank: ❑
Yes
Installer:
No
Date:
No
' /
❑
/
Certification #:
No
PVC Unions
❑
Yes
❑
No
*EHS:
❑
`Filter Brand:
❑
No
Anti -siphon Hole
❑
Yes
❑
No
ST Marker:
❑
Yes
❑
NO
Date:
nforced Tank:
❑
Yes
F1
No
Approval Status
❑ Approved ❑ - isapproyed
1 Piece Tank:
El
Yes
El
NO
/ Manufacturer:
PT:
Gallons:
Dosing Volume:
Date:
Draw Down:
Riser Sealed ❑
Yes
❑
No
Riser Height: ❑
Yes
❑
NO (Min. 6 in.)
Reinforced Tank: ❑
Yes
❑
NO
1 Piece Tank: ❑
Yes
❑
No
Pipe Size: 3 inch diameter
Pipe Length: 6 0 feet
*Schedule: 40
Pressure Rated ❑ Yes ❑ No
Approved fittings ❑ Yes ❑ NO
Pump Type:
Dosing Volume:
-
Draw Down:
Inches
*Chain:
Valves Accessible
❑
Yes
❑
NO
Flow Adjustment Valve
❑
Yes
❑
No
Check -valve
❑
Yes
❑
No
PVC Unions
❑
Yes
❑
No
Vent Hole
❑
Yes
❑
No
Anti -siphon Hole
❑
Yes
❑
No
Date:
Supply Line .
Installer: D Spencer plumbing
Certification #. 3440
*EHS: 2399 - Eldridge, Tiffany
Date: 0 6/ 1 7/ 2 0 1 6
Installer:
Gal Certification #:
*EHS:
Page 2 of 4
Date: / /
Approval Status
❑ Approved ❑ Disapproved
.4
CDP File Number 218724 - 1
L
County ID Number:
NEMA 4X Box or Equivalent
❑
Yes
❑
No
Installer:
Box 12 inches Above Grade
❑
Yes
ElNo
Certification #:
Box Adj. To Pump Tank
ElYes
❑
No
Conduit Sealed
❑
Yes
❑
No
*EHS:
Pump Manually Operable
❑
Yes
❑
NO
*Activation Method:
Date:
Alarm Audible ❑ Yes
Alarm Visible ❑ Yes
2399 - Eldridge, Tiffany
*Operation Permit completed by:
Authorized State Agent; Date of Issue: 0 6/ 1 7/ 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 a A. sewage septic system.
Rule .1961 requires that a Type TYPE II A. septic system meet the following criteria:
Minimum System Review By The Local Health Department: NIA
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a 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 by a public or private management entity, unless the
system owner and 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 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 O Import Drawing
**Site Plan/Drawing attached.** {'
Page 3 of 4
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC
Drawing Drawing Type: Operation Permit
CDP File Number: 218724 -1
County File Number:
27028 Date: 06/.17 /,2016
0 Inch
Scale: O Block
0 N/A
Page 4 of 4 P1 P2 P3
OPERATION PERMIT
Davie County Health Department
210 Hospital Street CDP File Number:
P.O. Box 848
Mocksville NC 27028 County File Number:
Date:. .
a Click below to import an image from an external location: Drawing Type:Operation Permit
Page 4 of 4 P1 P2 P3
Drain Field:
Septic Tank:
Pump Tank:
Supply Line:
Pump Requirements:
Electrical Equipment:
System Final Inspection Log:
P1 P2 P3
Chaadxa
Remeining
4000
Chaadxa
Remaining
4000
Chaadxa..
Remaining `
4000
Chandra
Remaining
4000
Chaedaa
Remaining
4000
Chaadxa
Remaining
4000
Parcel #: L60000004103
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 #:L60000004103 Account #:8305722
Owner Information
Tax Codes
ADVLTAX - COUNTY T
READVLTAX - FIRE TAX
1ST MORTGAGE CORPORATION
20 MARKET STREET
NOXVILLE TN 37902
BXI
99
Property Information
Township
nd (Units/Type): 2.600 AC
ddress: 6033 S NC HWY 801
JERUSALEM
ssessed:
104,18
eferred:
Deed Information
Local Zoning
Pate: 07/2016 Book: 01024 Page: 0717
Plat Book: Page:
2016 WD
Unqualified
Vacant
Legal Description
PIN
12.601 AC HWY 801
5756742584
Property Values
uiidin :
72,53 01
BXI
99
Land:
30,66
Market:
104 18
ssessed:
104,18
eferred:
Improved
Sales Information
No. Book Page Month Year Instrument
Qual/UnQual
Improved
Price
1 00440 0208 09
2002 WD
Unqualified
Vacant
0
2 01004 0564 it
2015 TD
Unqualified
Improved
94,000
3 01023 0919 07
2016 WD
Unqualified
Vacant
10,000
4 01024 0717 07
2016 WD
Qualified
Improved
110,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Page 1 of 1
oP�r�
0 b
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/itsnetfView.aspx?prid=1483927 8/30/2016