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144 Red Cedar Way _a �� • • . 4PERATION PERMIT °� '�e Se " " Davie County Health Department •CDP Fite Number 121362-1 �+���� 210 Hospitai Street os-000-oo-os2 � P.O. Box 848 County ID Number. � � � ���-�''' Mocksville NC 27028 Evatuated For. EXISTING Phone:336-753-6780 Fax:336-753-1680 Township. Appiicant: Donald and Betty Riddle Property owner: Donald and Betty Riddle Address: 162 Red Cedar Way � Address: 162 Red Cedar Way ��Y� Mocksville ��v� Mocksville State2ip: NC 27028 State2ip: NC 27028 Phone#: Phone#: Pro e Location 8 Site lnformation AddresslRoad #: Subdivision: Phase: Lot: 144 Red Cedar Way Mocksville NC 27028 Directions structure: SINGLE FAMILY 158 east� left on Farmington Road #of Bedrooms: � #of People: 'Water Suppty: wA "IP Issued by. 2244-Darivalt,Andrew 'System Clessification/Description: 'CA issued by: 2244-Daywalt.Andrew Saprolite System? QYes QNo � Design Flow: � 4 0 'Distribution Type: GRAVITY-SER►AL Pump Required? QYes QNo Soil Application Rate: . 3 *p e Treatment: WA � € Drain field N drification Field S4�ft� 'System Type: 25°!o REOUCTION INNOVATIVE OR ACCEPTEO No. Drain Lines Instaper. Total Trench Length: � 0 0 �. Certification#: Trench Spacing: _ 9 �Inches O.C. Feet O.C. 'EHS: 22�4-Daywalt,Andrew Trench Width: _ 3 6 �. Inches . gF�t o�t�: 4 / a 9 / a e i 3 Aggregate Depth: inches Minimum Trench Depth: Inches � Minimum Soil Cover. Inches Appraval Status _ �naximum T�ncn oePcn: O Approved� Disapproved � Inches Maximum Soil Cover. Inches C�o�v g��3 . EDP Fiie�fumber '121362 - 1 County ID Number: °�°0°-°°�0�2 Se tic Tank. Manufacturer. Sh°a� Lat. _ � Lot�g: , STB: Gallons: l000 InstaUer. Certification#; oec�: 1e / a6 / a � ia . . . yEH S: 224d•Daywa►t,Andrew . . 'Filter Brand: ST Ma�icer. ❑ Yes ❑ NO nate: a / a 9 I a e i 3 Approval Status Re�ntorced Tank: Q Yes O No p Approved O Disapproved 1 Piece Tank: O Yes � NO Pump Tank Manufacturer. Instaqer: PT: Certification#: Gallons: •EHS: Oate: � � Date: � � RiserSealed ❑ Yes ❑ No R'ser Heght: p Yes O No (Min.6 in.) Approval Status eintorced Tantc: ❑ Yes O No O Approved� Disapproved 1 Pisce Tank: D Yes ❑ NO Supply i.ine Pipe Size: inch diameter Instaper: Pipe Length: feet CertificaGon#: . "`Schedule: "EHS: P�essure Rated ❑ YeS ❑ NO Date: � � Approved Uttings ❑ YeS ❑ NO Approval Status ' O Approved❑ Disapproved , Pump Type: Instaner. • Dosing Volume: — �a� CertificaGon#: Draw Down: Inches 'EHS: 'Cha�: � � Date: Valves Accessible ❑ YeS ❑ NO Flow Adjustmeni Valve ❑ YeS ❑ NO Check-valve ❑ Yes ❑ NO Approval Status ' PVC Unions ❑ Yes p No ❑ Approved O Disapproved Vent Hole ❑ Yes � ❑ No Anti-siphon Hole p Yes ❑ NO • �Dp�ife Number' 121362 - 1 � � County ID Number: os-aoaoo•osz Electric E ui ment NEMA 4X Box or EquivaleM ❑ Yes ❑ NO Instaqer: Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ YeS ❑ NO Conduit Sealed ❑ Yes ❑ No xEHS: PumpManuatiyOperable ❑ YeS ❑ NO "Activation Method: Date: _ � � Approval Status Alarm Audibie � Yes O No ❑ Approved O Disapproved Alartn Visible ❑ Yes ❑ No 2244-Day�valt,Andrew *Operation Permit completed by: Authorized State Agent: Date of lssue: 4 / a 9 / a 0 1 3 This system has been instaqed in compliance w�h applicable NC General Statutes:ArtiGe 11,Chapter 130A, Rules for Sewage Treatment and Disposa1, 15A NCAC 18A.1900 ef. Seq..and an conditions of the Improvement Permit and Constnaction Author¢ation.This property is served by a sewage Septic system. Rule .1961 requires that a Type septic system meet the following criteria: Mi�imum System Review ByThe Local Health Department: Management Entity: F�Ainimum System InspectionlMaintenanceFrequencyByCertified Operator: Reporting Frequency By Certified Operator. Rule .1961 requires that a Type IV and V septic systems desgned fora home/business owner must maintain a valid contraci wdh a public management entitywRh a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires thatType VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator forthe life of the septic system. Rule.1961 (2)(e)requir�s a contract shall be executed between the system owner and a management entRy priorto the issuance of an Operation Permit for a system required to be maintained by a public or private management ent�y,unless the system ownerand certified operator are the same. The contract shaU require specific requirements formaintenance and operation, responsibiities of the owner and systems operator�provisions that the contract shall be in effect fo�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. � � 4Hand Drawing Olmport Drawing **Site PlanlDrawing attached.** . Total Time:(H H:��1�A) Activ�yCode: S-23C-OIPISSUED-REPAIRII 0 1 Houcs � g �.1lnutes , �,� • -• • � � OPERATION PERMIT Davie County Heaith Department CDP File Number: 121362 - 1 210 Hospital SUeet D5-OU0.o0-062 P.o.sox sas County File Number. Mocksvilte Nc , 27o2s Date: 1 / . . . � 1� VI 4 �• . Q lnch Drawin� Drawing Type: Operation Permit Scale: . . , QB�ck = . .ft. QN/A �� � s —T-- --T ! 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EXISTING � �.0. Qox 84a •`......• Totivnship: Mocksvitle NC 27028 PERt.11T VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 1 � 0 1 � 0 0 0 6 Applicant: Oonald and Betty Riddle Prope�ty Owner. Donald and Betty Riddle � Address: 162 Red Cedar Way Address: 162 Red Cedar Way • CdY: Mocksville � C�y: Mocksville State2ip: NC 27028 State/Zip: NC 27028 Phone#: Phone#: Propertv Location � Site Intormation Address/Road#: � Subdivisan: Phase: Lot: 144 Red Cedar Way Mocksville NC 27028 Directions Structure: SINGLE FAMILY 158 east, left on Farmington Road #of Bedrooms: 2 #of People: *Water Supply: wA System Specif�cations Minimum Trench Depth: a 4 Site ClassiTication: PS � Inches Saprolite System? QYes QNo � Minimum Soil Cover. Inches Design Flow: a 4 0 Maximum Trench Depth: 3 6 Inches Soil Applicatan Rate: . 3 Maximum Soil Cover. Inches `System Classification/0escription: 'DistributionType: Gw�vtTY-SERULL . TYPE 11 A.CONV SYSTEM(SINGLE-FAMIIY OR 480 GPD OR LESS) S@ptlC T8(1k: 1 0 0 0 Gallons 'Proposed System: 25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes QNo QMay Be Required Ndrification Field Sq. �. � PumpTank: Gallons No. Drain Lines 1-Piece: QYes QNo TotalTrenchLength: a � 0 ft GPM vs— ft. TDH Trench Spacing: 9 Qlnches O.C. Dosing Volume: Gatlons — QFeet O:C. — Trench Width: 3 6 � Inches _ gFest Grease Trap: Gatlons Aggregate Depth: - - - inches Pre Treatment: ONSF OTS-I OTS-II SepticTank InstallerGrade Level Required: �I 011 �III �IV Page 1 oi3 CDP File Number 121362 - 1 County ID Number. D5-000-00-062 • ❑ Open Pump System Sheet Repair System Required:OYeS ONo ONo, but has Available Space epair Svstem � Trench Spacing: Q Inches O. . =Site Classificatan: � — Q Feet O.C. Trench Width: Inches Design Flow: _ S Feet Aggregate Depth: Soil Application Rate: inches � Minimum Trench Depth: ��ches� *System Classification/Descnption: Minimum Soi1 Cover. Inches Maximum Tr�ench Depth: �Proposed System: Inches Maximum Soil Cover. N�rification Field S ft Inches 4 No. Drain Lines 'Distribution Type: TotalTrench Length: � Pump Required: QYes �No �May Be Required P�Treatment: ONSF OTS-I OTS-U � 'S(te Modifications No grading or constnicGon activity is allowed in areas designated for system and�epair without approval ot Health Depa�tment. "Permit Conditions The issuance ofthis permit bythe Health Department in no wayguarantees the issuance of other pertnits.The permit holder is responsible for checking wrth approp�iate goveming bodies in meet�ng their requirements. . ThIs Authorizatlon br Wastewater 5ysten C�stru�on shall be wlid for a person equal to the perlod of wlidiry ot the Improvanent Pertni;�at to euceed fiue years,and mry be issued at the sametime the Improvement Permit Iswed(NCGS 730A-3�6(b)�.If�e installation has not been completed duhng the period of volldiry ot the Corntructlon Pertnl�the Infortnatlon wbmitted In the appllcation tor a permlt or Constr�tlon Authorization Is found tio hav�been incornec�t�lsified or changed,or the stte is altered,the permlt or C�structi�Authorfaation shall become inwltd,and mry be suspe�ed a tevoiced(.193T(g)).The person awning or oortrolling the system shall be respo�iWe for usuring comptiance . with the laws,ntles.and permit conditlons regarding rystan Ixation,lnstallatia�f,operatlon,maintenaneq monitafng.rcporting and repair (1938(b)). , ApplicanUlegal Reps.SignatuFe Required� 4Yes �NO ApplicanULegal Reps.Signature� Date: � � •Issued By: naa•oaywaic,Andrew Date of Issue: �� 4 / a 9 / a 0 1�_ 3 Authorized State Agent: Malfunction Log �YeS 4Hand Drawing Olmport Drawing Toca�Tn„e:�HN:r����� , **Site PIan/Drawing attached.** Page 2 Of 3 � � Hours. 3 � Ia Inutes &10-CJA ISSUED-REPAlR • CONSTRUCTION AUTHORIZATION 121362 - 1 � . • Davie County Hea�th Department CDP Flle NUt11beP: 210 Hospital Street OS-000-00-062 P.o.soX eas County File Number. Mocksvilte NC 2�o2a Date: 0 4 1 � 9 / � 0 1 3 Q Inch Drawing Drawing Type: Construction Authorization Scale: . . . petock � . . _,ft. QN/A ' �_ `-I-1� ' ' ' ' ' ' F T � � iT � � ?�� � _ ;.�.�__:�_____?_....__ ___�._._... .._._._.__..__.:.._..�_._:.___.._!_.��.�_._._._._�...__;_.___,..�....____ _.�,_�.a__.._. .. _._. _ . . ..--- w_ , � �.___._ � � �--_— _�___—_� �_ i 1—_�_�_ '_� _f�_�� � ... .^..�-, ~. ____i_ ___����----� ; s f ! f � ' � ' � f t � . � , � 4 � i � � � �� a ► � � i_..�._m� ._�.� � � ; _._ .__. + __.__: ..._,r _ ___ _. _ _. _ _..__. ____;_.___ _._ __�. ---- -- — ._.�...�__�__ _._._ _. �.__ __.._� ��_ _.. _�_ � �_ _�__ .�� �_.._ _' ? _�I ( i�__._� 1._ 1 I "�_ _�_ �...� �--,� -- � � , � � � i _.._ ____� �_____�_____� _� �____� �____ � �—__� _�! ..�— °---- - 4 -- �~ �— � _! . ' __. ' ! _—�_—�- �---1---� ___� __�_I i � -- � ; � � � � { ► �_____.� _�--. � �_ i I _� �__�_ !__ 3__�_.�._ .. ._ ._ � .� � ._ ._. �_. _ ___ __ __ � _ W.r_ � .�_ �_. � u �.__���.__ � �.�_� �. �___,i___. _�_� _��_ !�_ �._ �i _��_ �i.__�_ �r.� _ � ___�_�. _!_. �I_ ,.� .�.,__ �.. � � _� ��� . � _�.�..._ ►____��� !� � i �i'__._ ___..'__ , w } i_ �___�_��.. °^ � �� �T�; - � � � --�� .��..�. __ �_�: _;._. .{ ��u_���i ;a.. �--� � � :��.��;�..____! �-- ���___._i_. 4�a� ►�_ � _1 � ._.����_____f � � �� � _�_ ��_ i� � __,_ �, � �,��� �� ; � � ;� ;� � � ; � � �.�_ .� _��--- --•.__ _ ____ 1 _ti i — .___�._. � __ ; � ; I I j—___a�_.�_ ,�_ :..___— , �`_ �_ � ( � _. __._ :._._... ..._. _�.�._..4_�_._.._..,�........,._.�..�...�_._. �. .�_......(.__.�_.� , .____.__w � .__.______;_ , '�p11�'0�.1. ..__�...0 ..��._.�.�__...�_�_..._....... t I i � i { ' � i �p j � t � f Xt ' Q ` u � � - - �-.-�- �- �---�-- :3_ �__.�_---I.-- --�_�__1_ _¢ ,__,_u� ,f----� --___� � _. _._. _ _ , — i � � i , ` � ` � ; , , ; �; i . _—� � — •--�� 4 �; , ��..� ; i ! ��.._� � � !_�..1_..__._I 'r�' � i � �___l._.____��. � � � �..�. �.�__... _ , 1____._..1__. �. .� � i I __l _..�_. _ __ _._ _._. . _...._ ..__ i I � i i ; , , , , ; I __ a � ! � I � a ,�,�� � , --�— �____ ____._____.___._____.__ . ___.—_--- -- - - ._ _._ . �__ , � � _ ._._.__--__,._—_.- ------ ��� � � � � i a l___�� � � -��_-- � � � �-- � --��—� -� �_____�.���_�._� '_- !� ._ � ( . ��� _ � -- � � -----��--- !___ _i_�__ +------ .� � �_�_.._�..� _ "� .��. ._;_ �.,:_ _i. _a-- , —�--- --� ;�� �: �_t_ � �. ��___.�_-___.__� . ._�- _jY_ I � _____�_ _ � � ��_ _�_� � � ��._. .�� �_-� ._ _i_�__r_ ++ _� __'� . I � i � ! { 1 � i � , � � � � -I V � � � � i � � I M � � � � � � _.�l.__.__�_ � i __.1.._...__.._ ! � �_W_l �....____ ;--_ _.�_._ ____-�--- ._�._.__..i.____..�.� _ � � ..._.'A ._�r � .�� __ __ ._ ..W...� __.I._ � � � _,_ _�_____� �_ ! ` � , I � , �_ _�.� � ; _�_ :____._ � �_;____ � +�____�►_� __���_ 1 _� � i_�� i 1 I �--- �-- ' ; _.� .__� � ` �. � ' .�,_._ ___._..,i___ �______ ____�_.._ ;_____�. � _ _�t � � _ � � � �.. � __..�_...�.w�__.___. � _ _��� � � � I _._ r ( _ � _ ' _�__._. ______,�.___. ___.-- ��_..�_._�-- _.� __�-- --�--- i_--�� I_ --+_ 1 � i-- --_I_ _._�_�__ � " ���. _�_»__..-�.� _;�- _.__I ; � i �– i �— � , i �^_€__,__ 1 _� � _�. ► �._�._ i _ ' _�� ' ��_ � _.. �._ � _�.�1...___ � _ ��___ _�� __ � �__�_�_ � I _ � �_____ �_� _,_. 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Pane 3 nf 3 _, ' For Office Use Oniv • - -- �[MPR�VEMENT PERMIT *CDP File Number 121362• 1 �:."""`• -Davie County Health Department � � t- � 210 Hospital Street County ID Number.��-�-�•�2 �. �� � P.O.Box 848 _ Evatuated For: EXISTING ♦�,,,.r• Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PER�a�rvA�w unri�: 4/29/2018 �NOTE TO INSPECTiONS DIVISION: Building Pennits cannot be issued with thia lmprovement Permlt Applicant: DOn81d 8r1d Betty Riddle Property Owner. Donaid and Betty Riddle Address: 162 Red Cedar Way Address: 162 Red Cedar Way �dY� Mocksville . �dY� Mocksville State2ip: NC 27028 State2ip: NC 27028 Phone#: Phone#: � Pro e Location 8 Site Information Address/Road#: � Subdivision: Phase: Lot: 144 Red Cedar Way Mocksville NC 27028 Dlrections structure: SINGLE FAMILY 158 east, left on Farmington Road #of Bedrooms: #of People: 'Water Supply: wA � S stem S eciflcations nitial S stem . "Site ass� �ca an: Minimum Trench Depth: Inches Saprolite System? QYes QNo Maximum Trench 0epth: Inches Design Flow: Septic Tank: ` 1 0 0 0 Gallons SoilApplicatan Rate: . . �-pfece: QYes QNo � Pump Required: QYes QNo OMay Be Required "System Classificatan/Description: Pump Tank: Gallons `Proposed System: 1-Piece: QYes �No Repai�System Required:OYes ONo ONo, but has Available Space Reaair Svstem � •Site Classification: PS Minimum T�ench Depth: a 4 Inches Soil Applicatan Rate: � . 3 - Maximum Trench Depth: 3 6 Inches 'System Classificatan/Description: Pump Required: QYes Q No Q May be Required TYPE 11 A.CONV SYSTEM(SINGIE-FAMILY OR 480 GPD OR LESS) . 'Proposed System: 25%REDUCTION Page 1 of 3 CDP Fii�Number '121362 - 1 County ID Number. D5-400-00•062 •Site Moditications ❑ Open Fitl Sheet No grading or construction activity is ailowed in areas designated for system and�epair without approvai of Health Department. '�Permit Conditions The issuance of this perm it by the Heaith Department in no way guarantees the issuance of other permits.The permit holder is responsibl� for checking with appropriate govemmg bodies in meeting their requirements. Site Plan The�p�nent Pertnit shaN be wlid tor S yevcs from dste ot issue with a sJte qan(means a drawing nat necessaMly drawn to O sale that shows the existtng and proposed property Ilnes with�menslons,the Ixatlon of thetacllity and appurtenances,the sile forthe proposed Wastrwatirr sys�em.and the loca�on of water wpplies and surricawate�s). Plat TMe Mprovernent Permit shab be�siid without expiratlon with plat(means a propMy 5urveyed prepared by a reglstered tand surveyor,dr�wn to a scate ot one inch equols no more than so feet,that I�luder.the spadilc location of the proposed fadlity O and appurtet�noes,v�e siteior ehe proposad Wastewater system,and the IocaUon ot waser supqies and surtace waters. Plat also means,tor subdiWsioe lots approved by the locat planning autt�ority and recorded witt�the county re�sterot deeds,a copy of the recorded subdivislons patthat is acoompaNed by a site ptan that Is d�awn to scale). The Departinent and Loal He�th Depar�nQnt may impasa oondfftorts oe the Issuance and mry rewke the permits tor failure a! the systan to sa�sty the eon�tlons,me n�es.or t�is arUcle 7t�is pertnit Is subJectto rc�acatlon If the si�e plan.pat,or in�ended use changes(NCGS 130A335(�).The peraon owNng or corrtrolQng the sys�em shail be responsfWe tor assuring compliance with the laws,ndes.and permit cond�tions regartiing system location.Instatlalion,opera�on,maintenincg moni�oring, repa�tlng,and repair(.1938(b)} Applicant/Lega1 Reps. Signature Required? OYes �NO ApplicanULegal Reps. Signature� Date: � � 'Issued By: ��'Daywalt,axire,nr Oate of lssue: 8 4 / � 9 / a 0 1 3 Autnorized state A9ent: OValid without Expiration? OCreate CA? OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** 7otalTime:(HH:�.,�,,� � � Hours 3 � 1.!tnutes Page 2 of 3 Activ�v Code: S-s-�P'S issued:reaa�rs . , , , IMPROVEMENT PERMIT 121362 - 1 ._ - ' DavieCountyHeaithDspartment CDP File Numbe�: 210 Hospital Street DS-000-00-062 P.o.Box s48 County File Number. Mocksville NC 27028 Dat2: / / Qinch Drawing Drawing Type: Improvement Permit Scale: . . , pBbck oN�A = ` ��. _i_:._ ..►�_Wa�.__.�____ � .�.. � ��^� �_.�._ � .� 1 ?..__..1__: ��___1��_:� �.�. ��� �:._� _.___ � i � � __�_ ..�__..__�_ �.�� ..�. � _ ._ ��_. , �_._ , � _,►____� �__�_�_� ��. � __�_._► � � _.�.� � ��� �`_ � ; ; a �. � � �---� _ G___._��__��__.�_....___.�____. ��.---_T_____--:_.�_,..__.�_._�_..___ �__�._:..____.�__�_ � �_ �.�_�_.._�.� � , � �� I I � !_�_I � ��_� ( ; I � � � � I -�.�. j�_�_ � � ._�_� �__._1� I_ 1 i i _ f . ?_ I � " _ i � i� ; 1 � -- 1 � — �� � a -- � ______+_ _ — — — ___._____,_____,_�___ .___.�_._ _ __�______.�_�_._ _ _ __ _ _._._._ ..____._ _ _ j � � � � I � i ; i ► i = ► _W . _ _v_ _ . __...___. �. _ _ _ �_ .�_lL..___ _�.. _w I . � .�.. �_.... �... � ..__� ��... _,..._.._.._. ..._.�: ..�..�Y=_�� �I,� � _.I_ ...�. ��.�`__�w .��- �� �._ ..�_ .1_ _���M�..� �i._ � —f— — a - � _ ` .__.�..�.._._ � ...,_�__...._� _ __�_ � � � �___._�_____i_ f � (�/� � � _.._. � .. i_� , , �.1�__: _�.. ,..._.._...��._.��._____. � _...}.._ �j �{ � ! ��.���____.��__:_._! _�� �� 1 ��_ � � � _1__�__I_ � Y�� I._�� __�____I 1 -_�_.� � .__l�� � ��_ ' _T�____��� �i� � �.�a � � � � ► ._ � i����____..�_ `��_ � , �— , �— , , - -�--. �� __ .�,._�. _�_� _ �__ _ � _. _.. . ► � � � _ W ! � f ! 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