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724 Pudding Ridge Rdr OPERATION PERMIT Davie County Health Department f� 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Sandra Ferraro Address: 724 Puddingridge Rd City: Mocksville State/Zip: NC 27028 Phone #: (336) 301-2857 Address/Road #: Subdivision: 724 Pudding Ridge Road Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: EXISTING WELL *IP Issued by. *CA issued by: 2140 -Nations, Robert Design Flow: 3 6 0 Soil Application Rate: 0 2 7 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: *CDP File Number 136979-1 E4-000-00-046 County ID Number. Evaluated For: REPAIR Township: t/Property owner: Sandra Ferraro Address: 724 Puddingridge Rd City: Mocksville State/Zip: NC 27028 one #: (336) 301-2857 Phase: Lot: Directions Hwy 158, east, left on Farmington Road, left on Puddingridge Rd. Property on Right before Buckeye Trail *System Classification/Description: TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) SaproliteSystem? OYes (S)No *Distribution Type: GRAVITY -SERIAL Pump Required? Q Yes GkNo *Pre Treatment: Drain 1 3 0 9 Sq. ft. a 3 a 0 8- 9 ()Inches O.C. 3 Feet O.C. Inches gFeet inches Minimum Trench Depth: 3 0 Minimum Soil Cover. 1 8 Maximum Trench Depth: 3 6 Maximum Soil Cover. a 4 *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Sherman Dunn Certification #: *EH S: 2140 - Nations. Robert Date: 0 3/ x 9/ 2 0 1 6 Inches Inches Approval Status Inches FF231 proved Ql Disapproved Inches CDP File Number 136979-1 County ID Number: E4.000-00-046 . - PT: Certification 9: Gallons: *EH S: Date: / / Lat. Manufacturer. ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes Long: , STB: 1 Piece Tank: ❑ Yes ❑ No ❑ Approved O Disapproved Vent Hole ❑ Yes ❑ Installer. Gallons: Anti -siphon Hole ❑ Yes ❑ No Certification *: Date: / / *EH S: "Filter Brand: ST Marker: ❑ Yes ❑ No Date: einforced Tank: ❑ Yes ElNo Approval Status ❑ Approved E3 Disapproved 1 Piece Tank: El Yes El No Pump Tank Manufacturer. Installer: PT: Certification 9: Gallons: *EH S: Date: / / Risersealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No / Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ No Approved fittings ❑ Yes ❑ No Date: Approval Status ❑ Approved ❑ Disapproved ` Supply Line Installer: Certification #: 'EH S: Date: Approval Status ❑ Approved ❑ Disapproved / 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 Status PVC unions ❑ Yes ❑ No ❑ Approved O Disapproved Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ No CDP Fite Number 136979-1 0-11L401111tom Asti 110111141110 County ID Number: E4•000-oao46 NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Seated ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ NO *Activation Method: Date: Alarm Audible ❑ Yes Alarm Visible ❑ Yes *Operation Permit completed by; Authorized State 1:1 N 0 Approval Status ❑ Approved ❑ Disapproved ❑ No 2140 - Nations, Robert Date of Issue: 0 3/ a 9/ 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 all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 11 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: N/A Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: N/A Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora hometbusiness owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe 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 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. GHand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Operation Permit 0- N I CDP File Number: 136979 -1 County File Number: 124-000-00-046 Date: 0 Inch Scale: OBlock ON/A _ CONSTRUCTION For Office Use Only 1 AUTHORIZATION 'CDP File Number 136979-1 Davie Count Health Department E4-000-00-046 Y P County 10 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/ 3 1/ a 0 1 9 Applicant: Sandra Ferraro Property Owner: Sandra Ferraro Address: 724 Puddingridge Rd Address: 724 Puddingridge Rd City: Mocksville City: Mocksville State2ip: NC 27028 State2ip: NC 27028 Phone #: (336) 301-2857 Phone #: (336) 301-2857 Property Location & Site Information Address/Road #: 724 Pudding Ridge Road Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: 'Water Supply: EXISTING WELL Subdivision: ,'Site Classification: Provisionally Suitable Saprolite System? QYes ()No Design Flow: a F c, Phase: Lot: Directions Hwy 158, east, left on Farmington Road, left on Puddingridge Rd. Property on Right before Buckeye Trail System Specifications Minimum Trench Depth: a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0.1 7 5 Maximum Soil Cover: a 4 Inches 'System Classification/Description: 'Distribution Type: GRAVITY -SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Se tic Tank 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: 1 3 0 9 Sq. ft. p Gallons 1 -Piece: QYes QNo Pump Required: QYes QNo QMay Be Required Pump Tank: Gallons 3 1 -Piece: QYes QNo 3 a 7 ft GPM—vs— ft. TDH — 9 8Inches O.C. Feet O.C. Dosing Volume: _ Gallons 3 8Inches Feet Grease Trap: Gallons inches Pre -Treatment: QNSF QTS -1 QTS -II Septic Tank Installer Grade Level Required: 01 Q11 0111 01V rays 1 V1 a L ,CDP Fire Number 136979-1 Repair s County ID Number: E4-000-00-046 ❑ Open Pump System Sheet Requlrea:lJres vivo vivo, Dui nas HvallaDle -)pace Total Trench Length: ft. Pump Required: OYes ONo OtAay Be Required Pre -Treatment: ONSF OTS -1 OTS -11 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7; "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. ;„ 2( 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 maybe Issued at the same time the Improvement Permit issued (NCGS 130A-33G(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/ 3 1/ a 0 1 4 Of OF Authorized State Agent: Malfunction Log OYes OHand Drawing Otmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 Trench Spacing:Q Inches 0. 'Site Classification: — Feet O.C. Trench Width: Inches Design Flow: _ 8Feet 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 ONo OtAay Be Required Pre -Treatment: ONSF OTS -1 OTS -11 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7; "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. ;„ 2( 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 maybe Issued at the same time the Improvement Permit issued (NCGS 130A-33G(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/ 3 1/ a 0 1 4 Of OF Authorized State Agent: Malfunction Log OYes OHand Drawing Otmport 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: 136979 - 1 County File Number: E4-000-00-046 Date: 03/31/x014 Olnch Scale: OBlock ON/A Paae 3 of 3 DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR Name FII ld4a-Aq l'��._t� Telephone Number Address , l Q Mailing Address (if different from abov7—�0��~ Email Address: Subdivision Name Lot # Directions i Date System Inst lled Inod Name System I/gstaallle Under Type Facility Se ! UZumber Bedrooms C7 `NUor'People Served Type Water Supply Specific Pro lem Occurring,(/��%(� Date Requested Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason 3Co� Revised 2-2011 Appraisal Card View All Cards Next Card Page 1 of 1 312S/201411:4536 AM OWnc FERRARO DAVID JOSEPH SR FERRARO SANDER HASTER etum/Appeal Notes: Parcel: E4-000.00-046 24 PUDDING RIDGE RD PLAT:/ UNIQ ID 6208 301147 D122 -P32 ID NO: 5831881786 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 2 Reval Year: 2013 Tax Year: 2014 5.00 AC PUDDING RIDGE RD 4.760 AC SRC= Inspection kippralsed by 02 on 06/22/2007 03003 CEDAR CREEK TW -03 Cl- FR -08 EX- AT- LAST ACTION 20121029 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 Eff. BASE Standard 0.190 ntinuous Footing 5.0c US MO Area QUA RATE RCN EYB AVB CREDENCETO MARKET ub Floor System - 4 I wood 8,0 Ol Ol 12,89811321 92.40 �7113419941874 % GOOD 81.0 DEPR. BUILDING VALUE - CARD 219,62 xterior Walls - 09 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE- CARD 11,46 ood on Sheathing or Plywood 30.00 MARKET LAND VALUE- CARD 61,89 STYLE: 3 - 2.0 Stores TOTAL MARKET VALUE - CARD 292,97 �Dofing Structure - 03 able 8.0 oofing Cover - 03 TOTAL APPRAISED VALUE- CARD 292,97 s halt or Composition Shingle 3.00 TOTAL APPRAISED VALUE- PARCEL331,65 nterior Wall Construction - 5 )rywall/Sheetrock 26.00 TOTAL PRESENT USE VALUE - nterior Wall Construction - 6 AIX PARCEL ustom Interior 0.0c TOTAL VALUE DEFERRED- PARCEL nterior Floor Cover- 12 19' FUS 19' TOTAL TAXABLE VALUE- PARCEL 331,65 ardwood 14.0 42' PRIOR eating Fuel - 03 s 1.0c 3UILDING VALUE 221,23 eating Type - 10 BXF VALUE 15,83 Heat Pump 4.0 LAND VALUE 61,89 it Conditioning Type - 03 29' 7' PRESENT USE VALUE entral 4.00 DEFERRED VALUE OTAL VALUE 298,95 edrooms/Bathrooms/Half-Bathrooms 23, 1/2/1 15.00 2r 34' Bedrooms 6' BAS - 1 FUS - 3 LL - 0 PERMIT athrooms 6' CODE DATE NOTE NUMBER AMOUNT AS - 1 FUS - 1 LL - 0 � BA ` �. UP If -Bathrooms SIC 24' OUT: WTRSHD: AS - 1 FUS - 0 LL - 0 26' 7' SALES DATA ffice FF. NDICATE AS - 0 FUS - 0 LL - 0 6' T 19` RECORD DATE DEE SALES 25' DIAL POINT VALUE118.00 6' 42' BOOK AG MO R TYP PRICE BUILDING ADJUSTMENTS 1Y 089 721 6�01 WD Q I 5250OCCall 4 ABAVG 1.200 2(s' FQP 21' 033 741 500 WD Q I 20000 ha a/Desi 4 FACTOR 4 1.050 , 1S . 015 664 1 99 WD Q I 11500 Size 1 3 1 Size 1 0.890 TOTAL ADJUSTMENT FACTOR 1.12 TOTAL QUALITY INDEX 13 HEATED AREA 2,677 Click on Image to enlarge NOTES SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR. TYPE GS AREA I ^/o JRPL CSS ODE DESQtIPTIO COUN LTH H NIT PRICE COND BLDG*AYB EYB RATE OV COND VALUE AS 1,801 10 16715 5 ARN 24 44 1,05 15.00 loo _ 197 1994 S3 43 681 EP 7 07 452 4 HED 28 44 1,23 SAC IOC _ 197 1994 5 31 1 ORAC� 1 2 33 15.0 10 197 199 5 4 216 OP 921 035 2975 1 ORALE 1 2 33 15.0 _ 10 194 199 5 4 216 FUS 79 09 6634 OTAL OB XF VALUE 4 - 2 Story Single/1 Story 11,45 REPLACE Double 3,36C UBAREA OTALS 3,59 71,13 BUILDING DIMENSIONSFOP=W7S34E23MW36N27Area:350;BAS=W29S23E6S24E756E42M9W26N34Aiea:1809;FOP=S12E20S4E15N4E21N25V7S19W42N6W7Area:571;FEP=N7 W10S7ElOArea:70;FUS=N19W42S19E42Area:798;SRH=E6N24W6S24Area:144•TotalArea:3742 LAND INFORMATION IGHEST THER ADJUSTMENT TOTAL NO BEST USE LOCAL FRO N 1CODEIZONING DEPTH / LND COND ND NOTES OA LAND UN LAND UNT TOTAL ADJUSTED LAND OVERRIDE LAND SE TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE VALUE NOTES FR MIN FM 0134 402 0 1.0000 0 1.0000 PW 13,000.0 4.761 AC 1.0ol 0 DIAL MARKET LAND DATA 4.761 61,890 OTAL PRESENT USE DATA lv'e.i� be Wo -A �- t044ilt Or -06e., http://maps.co.davie.ne.us/ITSNet/AppraisalCard.aspx?parcel=E400000046 3/25/2014 D County Health Department X18 j�EGEnonmental Health Section a JUL 2 7 ?til;' P.O. Box 848 0 � �,5 ;� 210 Hospital Street O U �'� Y: Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Fax: (336) - 753-1680 Name: e -m 61,113;hvch-d-11 TvrG Phone Number 33G 3Q`I``/�9� (Home) Mailing Address: 2,83 f'YPPt�`h'*c DJ— (Work) ��l�syr'/ft AIC 27027 Email Address: q jrCM4iArCbta7 � /baG�lYiirn�r�G��`r Detailed Directions To Site: ftWY601 KJ 7o La K2 id /U On Luna %v Poddr 2 %t'r'4c r- %v o f-, Poe 4'W Property Address: 77-y PaJd,� A Jye. RA flachfviflc L -f1)000604 r- _ -//, Please Fill In The Following Inform ti About The EXISTING Facility: Name System Installed Under: 12_ Type Of Facility: f rP Date System Installed (Month/Date/Year): � Number Of Bedrooms: Number Of People: 3 Is The Facility Currently Vacant? Yes G If Yes, For How Long? Any Known Problems? Yes (9, If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: f,,, Nd, bi-, 16 007 Number Of Bedrooms:__0 Number of People., Pool Size: ------- Garage Size: Other:of 4 of ---�— Requested By: Date Requested: 1-77 2o�z i nature) .,, For Environmental Health Office Use Only Approved isapproved Comments: Environmental Health Specialist. Date: *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash r econey Order # ��x �S Amount:$ Date: Paid By: QP 19 Received By: Account #: �2b3 Invoice #: Tax Lot 46 T— KA-- C A s. - - ------------- --- Pudding Ridge Road --- ------- - S.R. 1435 Sit, Plan 1— David Joseph Ferraro, Sr. Sanders Haste Ferraro S—,.q Company 1p - - ------------- --- Pudding Ridge Road --- ------- - S.R. 1435 Sit, Plan 1— David Joseph Ferraro, Sr. Sanders Haste Ferraro S—,.q Company