Loading...
139 Sawgrass Drive Lot 292OPERATION PERMIT Davie County,Health Department 7colPik119 � Numtter. 123663 1 a� 210 Hospital Street s ; Es-00o`-600Z� „ P.0'. Box 848 Couriiy tD Number Mocksville< NC, 27028; Evaluated For• NEW Phone: 336-753-6780 Fax: 336.753-1680 Sownship"; Applicant: Isenhour Homes Property owner. Isenhour Homes Address: 3411 Healy Drive Address: 3411 Healy Drive CRY: Winston-Salem CRY: Winston-Salem State/Zip: NC 27103 State2ip: NC 27103 Phone #: (336) 659-8211 Phone #: (336) 659-8211 Property Location & Site Information Address/Road #: Subdivision: Sawgrass Phase: Lot: 292 139 Sawgrass Drive Advance NC 27006 Directions Hwy 158, turn right on 801, then turn right on Mocks Structure:, SINGLE FAMILY Ch Rd., go to end then right, Developmenton right # of I3ednlomss 4 # of People: Water Supply: PUBLIC *IP Issued by. 2140 -Nations, Robert *System Classification/Description: *CA issued by: 2140. Nations, Robert SeprotiteSystem? OYes ®No Design Flow: 4 8 0 * GRAVITY -SERIAL PumplRequimedl? *Distribution OYes ®No Soil Application Rate: 0 3 *Pre -Treatment: Drain field Nitrification Field 1 6 0 0 Sq. ft. *System Type: INFILTRATOR OUICK 4 STANDARD No. Drain Lines 5 installer: Tim Beeson Total Trench Length: 4 0 0 ft. Certification #: Trench Spacing: — 9 Inches O.C. sFeet O.C. *EHS: 2140 -Nations, Robert Trench Width: — 3 Zeal: •Feet 0 3/ 1 a/ a 0 1 4 Date: Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4t, Inches -'Approval Status Maximum Trench Depth: ,3 6 "® Approved �'-Disapproved Inches Maximum Soil Cover: 2 4 Inches CDP File Number 123663 -1 County ID Number: E9,000 -M292 Manufacturer. shoal ❑ No (Min.6 in.) Lat. No STB: 760 , No ❑. Approved ❑ D'isapproved ' Long: ❑ Yes Gallons: 1000 Installer: Tim Beeson Date: 12/ 1 9/ a 0 1 3 Certification #: 'EHS: 2140 - Nations, Robert "Filter Brand: POLYLOK PL -122 With Pipe Adapter Date: 03 / 1 / am is ST Marker. ❑ Yes ® No inforced Tank: [J Yes ElNO _ Approval Status ®Approved ❑ Disapproved ' 1 Piece Tank: ❑ Yes 0 No Pump Tank Manufacturer. Installer: PT: Gallons: Date: / Riser Sealed ❑ Yes R'serHeight: ❑ Yes nforced Tank: ❑ Yes 1 Piece Tank: ❑ Yes FA ❑ No ❑ No (Min.6 in.) ❑ No ❑ No Pipe Size: inch diameter Pipe Length: feet 'Schedule: Pressure Rated ❑ Yes ❑ No tpproved fittings ❑ Yes ❑ No Certification #: 'EH S: Date: Approval Status ❑ ApprovedO_Disapproved Installer. Certification #: THS: Date: / — ApOrqV ❑ Approved / Pump Type: Installer. Dosing Volume: - Gal Certification #: Draw Down: Inches 'EHS: 'Chain: / Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No / us: isapproved / Check -valve ❑ Yes ❑ No Approval Status;: PVC, unions ❑ Yes ❑ No ❑. Approved ❑ D'isapproved ' Vent Hole ❑ Yes ❑ No \ Anti -siphon Hole 0 Yes ❑ No i 'CDP File Number 123663 -1 County ID Number: E9•000-00-292 NEMA4X Box or Equivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj,To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EH S: Pump Manually Operable ❑ Yes ❑ No 'Activation Method: Date: 1 11 Awrm'Audible : :Yes Alarm Visible ❑ Yes 1:1 NO Approval Status_ F1 No ❑'Approved❑ bisepproved s 2140 - Nations, Robert *Operation Permit completed by Authorized State Agent: Date of Issue: 0 3/ 1 2/ 2 0 1 4 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 Of. Seq., and all conditions of the improvement Permit and Construction Authorization. This property is served by.a sewage septic sptem. Rule AM requires that a Type septic system meet the following criteria: Minimum System Review ByThe Local Health Department: Management Entity: Minimum System InspectionlMaintenance Frequency By Certified Operator. Reporting Frequency By Certified Operator. Rule .1961 requires, that a Type IV and V septic,systems desgned fore home/business owner must maintain a valid contract With a public mariagemententitywkh a certified operatorora 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 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 entfiy prior to the issuance of an ;Operation Permit fora system required to1. be maintained by a public. or private management entfiy, 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 operetor, provisions that the contract shell be in effect for as long as the system is in use, and oth'errequirem66ts for the continued proper performance of the system. R shall also be a condition of the Operation Permit that subsequent-ownets'of the,systems execute such a contract, *Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** ;CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Isenhour Homes Prop r - ror unlce use unry `CDP File Number 123663-1 County ID Number. Eg-000-00.292 Evaluated For: NEW Township: PFRA/FT-Uhl Ill I IMTII 1 0/ 1 8/ 2 0 1 8 Owner: Isenhour Homes Address: 3411 Healy Drive Minimum Trench Depth: 2 4 \ Address: 3411 Healy Drive CRY: Winston-Salem City: Winston-Salem State2ip: NC 27103 Design Flow: 4 8 0 State/Zip: NC 27103 Phone it: (336) 659-8211 Phone #: (336) 659-8211 Address/Road #: 139 Sawgrass Drive Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: 'Water Supply: PUBLIC Subdivision: Sawgrass Phase: Lot: 292 Directions Hwy 158, tum right on 801, then turn right on Mocks Ch Rd. go to end then right, Development on right / Minimum Trench Depth: 2 4 \ Site Classifx:atan: PS Inches Minimum Soil Cover. Saprolite System? OYes ®No Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover. 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% REDUCTION 1 -Piece: OYes ®No Pump Required: OYes @No OMay Be Required Nitrification Field Sq. ft_ Pump Tank: Gallons No. Drain Lines 1 -Piece: OYes . ONo Total Trench Length: 4 0 0 GPM—vs— ft. TDH g- Trench Spacing: — QInches O.C_ oFeet O.C. Dosing Volume: Gallons — Trench Width: Inches 8Feet — Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -11 OTS -II Septic Tank Installer Grade Level Required: 01 011 0111 OIV Page 1 of -. CDPFile Number $23663.-1 'Site Classification: PS Design Flow, 4 8 0 Soil Application Rate: 0 3 'System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: 4 0 0 ft, County ID Number: E9-000.00.292 ❑ Open Pump System Sheet ONo ONo, but has Available Space Trench Spacing: _ O Inches O.C`. o Feet O.C. Trench Width:O Inches ,--8Feet . Aggregate Depth: inches Minimum Trench Depth: 2 .4 Inches Minimum Soil Cover. Inches Maximum Trench Depth: 3 g Inches Maximum Soil Cover. Inches Sq. ft. 'Distribution Type: PUMP TO GRAVITY _ Pump Required: ®Yes ONo OMay Be Required Pro -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. II '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 bevalld for a person equal to the period of validity of the Improvemern Permit, not to exceed five years, and maybe Issued at the sametlme the Improvement Pemrit Issued (NCGS 130A -339(b)} N 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 became Invalid, and may be suspended or revoked (.1937(9)). 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 ®No Applicant/Legal Reps. Signature: Date: 'Issued By, 2244-Daywalt,Andrew Authorized State Agent: Date of Issue: 1 0/ 1 8/ 2 0 1 3 Malfunction Log Oyes. ®Hand Drawing OlmportDrawing Total Time:(HH:MM) **Site Plan/Drawing attached.** Page 2 0f 3 0 0 Hours. 3 0 Minutes S-8 - CAS Issued - new CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 123663 -1 County File Number. E9-000-()0.292 Date: 1 0/ 1 8/ 2 0 1 3 W W Q Inch Scale: . QBlock Pane 3 of 3 RECEIVED APPLICATION FOR SITE EVALUATIONIIMPROVEMF..NT PERMIT t& ATC 1%I(t11 D Davie County Environmental Ilealth P.O. Box 848/210 Ifnspital Street hiockcville, NC 27028 (336)753-6780/ Fax (336) 753.1680 - Application For: O Site Evaluationtlmprovement Permit O Authorization To Construct(ATC) Both Type of Applmation�X,: .w System URepairtobluting System DExpanston/Moddication ofExis ar Facility 1 'Vh1PORTANP•• TTIIS APPLICATION CANNOTBE£ROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed SSS U JV YY`t'Q, - Contact Person ��UY 0Y 0- Cr W 1~ Billing Address 3 __ I� Home Phone - o S SC r71 City/State/LIP W , Y' S� vv. N C Business Phone - a -L I. (0-3 Name on Pctmit/ATC if DiJjerent than Above Mailing Address - City/State/Zip Property Lot Sizc 0 must accompany ghs with site play to O N V-\ If the answer to any of the lot lowing questions is'yes', supportidg documentation must be attached. Are there any existing wastewater systems on the site? []Yes qNo Does the site contain jurisdictional wetlands? DYes No Are there any easements or right-of-ways on the site? OYes INo Is tire an e Nile subject to approval by other public agency! OYes No Will wastewater other than domestic sevsaec be seneroted? DYes No FILL People i #Bedrooms L # {� �CU�D :i4k.711]_pll`C�La� d l'tR1ly III Y :1 a�: fo):1 t] gRe�Yl Garden ONO Type ofFacil ityBusiness Total Square Footage of Building R People # Sinks - # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility .eater consumption) FOODSERVICE ONLY: #Seats Type system requested: Aonventionol r�Accepted Dlnnovative OAltemative OOther Water Supply Type: curl Water - O New Well ❑Existing Well D Community Well Do you anticipate additions orexpansions of the facility this system is intended to serve? O Ycs qmo 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. 1 understand thatany purmit(s) or ATC(s) issue) lie,mftct ars subject. to suspension or revocation ifthe 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 Representative of the Davie County Heal dr Department m conduct necessary inspections to determine compliancewith applicable Jews and rales.. l understand that 1 am responsible for the proper identification and labeling of property lines and comers and locoline and gaggingor staking the hnus<acility location, proposed well location and the location of arty other amenities. ( Site Revisit Charge Property owner's oruwncr's lcgnl representativeign urc Client Notification Date; Date EHS; Sign given CYes ONo Revised 11/06 al"iAm A Account N Invoice 8 1124 07 0 n N n N. 03d 11'01'11 0099' • r I �.® I II r. I I � I I I Lo BACK Lou i I� I I la m � � IBi I� BETT 2 ILBACKJ. I I I I I I I ® I I l ti y J� JN�� I IIP I x ru'r i/�F I — ..—m'•0'IIiIL11Y EASEHENf I. � .._ /` � f � � .. . . 03d IB' 35' III. 119p19' SA ZRA55 DRIVE --------------- it 11 .SITE PLAN w _ Rilzml I %YDUMN060NLY, LOT NUMBER N i n _ "SAWG190mN"IS E N N 0 0 R_ —"'S OAK �1.� �_ K.�'���-- ��' PENDLETON TRADITIONAL V Appraisal,Card NC Page 1 of 1 9/5/2013 10:21:14 AM AK VALLEY ASSOC LTD FIBER P Retum/Appeel Notes; E9-000-00-292 139 SAWGRASS DR UNIQ ID 6975 4303000 ID NO: 5871244634 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of I Reval Year: 2013 Tax Year: 2014 LOT 292 OAK VALLEY SAWGRASS PH I 1.000 LT SRC- ra1se0 bV 19 00 11104/2008 03107 OAK VALLEY TW -03 C- EX- AT- LAST ACTION 20130419 M457RUCTION DETAIt MARKET VALUE DEPRECIATION CORRELATION OF VALUE OTALPOINTVALUE ER. BASE BUILDING USE MOD Area QUAL RATE RCN EYBAYB - REDENCETO ADJUSTMENTS 9) DO %GOOD )EPR. BUILDING VALUE - CARD OTALADJUSTMENT TYPE.VaWnt )EPR. OB/XF VALUE -GRD ACTOR _ MARKET LAND VALUE -GRD 67,00 OTAL QUALITY INDEX STORIES: OTAL MARKET VALUE -GRD 67OO OTAL APPRAISED VALUE -CARD 67,00 OTAL APPRAISED VALUE - PARCEL 6700 OTAL PRESENT USE VALUE - PARCEL OTAL VALUE DEFERRED - PARCEL OTAL TAXABLE VALUE - PARCEL 6700 PRIOR UILDING VALUE BXFVALUE LAND VALUE 95,00 PRESENT USE VALUE DEFERRED VALUE OTAL VALUE 95,000 PERMIT CODE I DATE I NOTE I NUMBER AMOUNT OUT; WTRSHD: SALES DATA FF. ECORD ATE DEED INDICATE SALES - OOK PAGE M R I TYPE / PRICE 0652 ID11 3 00 WD I % I V HEATED AREA NOTES SUBAREA UNIT ONUS% SIZE ANNDEP % OB/XFDEPR. GS RPL OD UA DESCRIPRO TN MIT PRICE COND LDG / FACT Y RATE V CORD VALUE TYPE AREA CS OTAL OB XF VALUE FIREPLACE - UBAREA OTA. UILDING DIMENSIONS AND INFORMATION HIGHEST THERA)JUSIMENTS TOTAL ND BEST USE LOCAL FROM DEPTH/ LND COND ND NOTES ROA LANDUNIT LAND UNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGE DEPTSI2E MOD PAR RF AC LC TO OT TYPE PRICE UNITS TYP AD3ST UNIT PRICE VALUE NOTES FR RES 0100 0 1 0 1 1.0000 1 0 1 1.0000 67,000.0 1.000 LT 1 1.00 67,000.0 6700 OTAL MARKET LAND DATA 67 00 OTAL PRESENT USE DATA 0 http://maps.co.davie.ne.us/ITSNet/AppraisalCard.aspx?parcel=E900000292 9/5/2013 /Ve1' id U•J' Ud:-+O)a - JJV /.JT -JJVJ •+,.; T--nPPtlr7?'fsONFOn SIiEEVALWnON/)h1I7tOVBIrNr PEnsfrr&ATO Oavio County Health C Iparlment - - a viAMMenta/Hrv7LISecbOn P.O. Box adC/210 Poop ttal Street tracksvillor NC 27020 - - (336)751-e7c0 e••L4PORTANTvee THIS APPLICATION{ CANNOT DE PROL.ISSSD MME,,,5 ALL TSG IlE0unp 1*,*C NATION IS PROVIDED. E09W x0 tho INLVIDAT::ON SOME= for inotruetiann. A. It— m U. alllad VFri v -1%1. 1 HIS.ss,.rs KAa YG?tti"cs'npee I .. ISO Ufua Actor.. Ar.m N't•'!, !]/: lbw. Pmnc ctar/Loarw:xa �+hfh'�--5�4„, 1p1G -.�'71t5LLS avemee.. rmne f�G' 7rI `l 3iyi 7. Maw ea y.st 4Aac SC alC[atmt Cban >t.va 1 dt_i 70 � �f(' yt�a nl.� Nat13nP Statue .i Fs,.l City/;:Cato/L1p � 1. ApptieaeSoa Fort dsLc L'Valuatiaa ❑ ILCmovovwnt I-wauit/ATC 0 Both e. Ly.m. to sets'— SeRouea O stabile BoIDo D "Mul iL... O Toduu ri ❑ othor L. aype orate. >vaw.t.a: Vra.uamt O c..vo.tmnal:UvSfted ❑ Snnova4v. pDCCClrxad 1. re��itmtdenea: a Paopla� � f Dedroccas LL -0 Datbroo" 7 FdolaMreamr �rtarba0. ataptaal 7dp>ahtng y .0 oe N:u.em.t/P1uWlnp Om.e.enCAto Pluabtnp V. T[ Dvetn aa/Iadvatey 10user: vulfy type p ..a. I SuA. V cat ­se. _ / aawary 0 Url.a. a Natmr Coale,. IF PDODDEEVICS: 0 Seats; EntimaCed Ha tar Bongo taallmu per day!' 0. arpe of varve ..ta.Syo to C0=WCity ❑ Hai l ❑ Community // s. Do w. aatp.L. Addttto,u or eapausiotn ofthe facnity this sysasaun intended to secy Q Yet C Na Irycs. Irhat typo: -- PROPERTYINPOI:h4 TION f- • CSlnIo�IVid)U1. it'IJlr�d]"'^• P 1'ru)rcrly Uimutsiatts'. i4L OL2 _ ! WRITE )IRECnONS (rtatuhledavt0e) Io VB0pFjt1Ye- - Tax OI6re1'IN: D aS1' I Property Address: Road Name_ ASI, 044!j ?"i 4pfzvyj NS, j✓L1 Ji- _ " Gtynp_ -ICin aSnhdivision gravida lnfarnulion, as fo0ows: ' Name: Sectio Block: Lot: 3 Date Ito' It cornets flagged: This is fa certify Rul the i ilwaaaffon provided ti correct to the but of my k osvledgn 1 understand that any pentdl(s) - - Issued hereafter aresubJeet to suspension or revocation, if !Resile plans or 1. tended we change, or tithe fusoanstupn subndned in this AppOeatfen it fahir d or ehmtged. f, afso, undrrtraudrhar.' a.I rup...Mefora If utvgh,currrdfrom ZBapplicefivo. Lherebp, gist consmtl la(fie Aulbdriard Repraentat!" ordte Dayie Counp•Ifea1111y,Department Io enter upon abort daeribcd property located At Davfe County and asst ;MOV-11-(ito eonducl aft testing proud uses as oc,=4r • to delemdne NL site suiljh fin)'t _ SIGNATURE TUISARE\MAY BE USED FORDIWRING YOUR SMEMAN(I�nduddeeall of0te following: LxIstingandproposed property Boa and dfmmslotls, structure, setback:, and septic locnacus). ' Silt Revisit Chane - Duta(s)l - • ClicutNaRBoUmi Dale: EAS Sica given - Account Ne. - I a&W DCIIU (05143 Iuvol¢Na. OPERATION PERMIT ` Davie County Health Department 210 Hospital Street b P.O. Box 848 Mocksvilte NC 27028 Phone: 336-753-6780 Fax: 336-753.1680 Applicant: Isenhour Homes Address: 3411 Healy Drive City: Winston-Salem State2ip: NC 27103 Phone #: (336) 659-8211 Property owner. Isenhour Homes Address: 3411 Healy Drive City: Winston-Salem State/Zip: NC 27103 Phone #: (336) 659-8211 Pronertv Location & Site Information Design Flow: 4 8 0 Soil Application Rate: 0 3 Nitrification Field No. Drain Lines Total Trench Length: 1 6 0 0 Sq. ft. 5 Address/Road #: Subdivision: Sawgrass Phase: Lot: 292 4 139 Sawgrass Drive ft. Advance NC 27006 Directions Structure: SINGLL E FAMILY Hwy. 158, turn right on 801, then turn right on Mocks '4 Ch Rd. go to end then right, Development on right # of Bedrooms # of People: "Water Supply: PUBLIC 'IP Issued 6Y..' 2140-Nations,Robert 'System ClassifioatanlDescription: _ TYPE II A CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140 - Nations, Robert Design Flow: 4 8 0 Soil Application Rate: 0 3 Nitrification Field No. Drain Lines Total Trench Length: 1 6 0 0 Sq. ft. 5 4 0 0 ft. Seprohte System? OYes pr No 'Distribution Type: GRAVITY -SERIAL Pump Required? OYes QNo *Pre -Treatment: In field 'System Type: INFILTRATOR QUICK 4 STANDARD Installer: Jamie Bames Trench Spacing: 9 Inches O.C. 2 Feet O.C. Trench Width: 3 • Inches Feet Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: 2 4 Inches Certification #: 'EH S: 2140 -Nations, Robert Date: 0 3/ a 8/ a 0 1 6 Approval Status ,n •AnrinvPi11-1'rlicannrnvPd•-.'. CDP File Number 123663 -1 Manufacturer. STB: No Gallons: NO (Min.6 in.) Date: Gallons: RiserSealed ❑ Yes RiserHeght: ❑ Yes Date: Yes `Piece Tank: ❑ Yes_ 'Filter Brand: ST Marker ❑ Yes ❑ No enforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Manufacturer. PT: No Gallons: NO (Min.6 in.) Date: / RiserSealed ❑ Yes RiserHeght: ❑ Yes einforced Tank: ❑ Yes `Piece Tank: ❑ Yes_ rA ❑ No ❑ NO (Min.6 in.) ❑ No ❑No._. Pipe Size: inch diameter Pipe Length: feet "Schedule: Pressure Rated ❑ Yes ❑ No ,pproved fittings ❑ Yes ❑ No County ID Number: e9•00000 -29 I Lat. Long: Installer. Certification #: 'EH S: Installer: Certification #: 'EH S: Date: / / Date: Ap ❑ A' / Pump Type: Installer. / Dosing Volume: — Gat Certification #: Draw Down: Inches 'EHS: 'Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No roved Check -valve ❑ Yes ❑ NoApproval Status PVC unions ❑ Yes ❑ No ❑ approved ❑ Disapproved Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes 0 No CDP Fite Number 123663-1 County ID Number: E9.000.00.292 NEMA4X Box or Equivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Approval Status. Alarm Audible❑Yes ❑ NO ❑ 'Approved❑ Disapproved Alarm visible 171 Yes El No 2140 - Na Robert *Operation Permit completed by: /)tions, Authorized State Agentr��!r _ l` Date of Issue: 0 3 / a 8 / 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 at, Seq., end all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE II 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 - --- Minimum System Inspection/Maintenance Frequency By Certified Operator: 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 operatoror a private certified operator forthe life of the septic system.II Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract v{ith a public management entdywfth a certified operator for the life of the septic system. II 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 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 shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. OO Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** ''`` OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksvilte NC Drawing Drawing Type: Operation Permit CDP File Number: 123663-1 County File Number: E9-000-oo-292 27028 Date: W W Qlnch Scale:. . . (Block ON/A ■■■ ■ ■ ■MMM ■M j amm ■ -- _ " " -FF �� ■� ■ ■ ■ ■ ■■■ ■■■ ■■■■ !iiii ■ ' MMMM■mmm ■■■ i i ■ ■ ■ ■ ■■ ■■ ■■■■■■ ■■■ 9 ■■■ MMMMMMMMM ■■ , ■■■■■■ Im■ ■■■■ ■■ ■ ■ ■ ■ ■■■■ MM■■ ■■■■ MMM MMM■ mm ■■ ■■■..■ ■E■■■■■ MM ■■■�■ ' MM ' MMM ■ MMM �m mm■m■■■■■■■M■ ■MMM■■ ■ ■ —,-CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Scott Hurdle/ S&R Enterprises Address: 182 Mallard Landing Blvd CRY: Clemmons State/Zip: NC 27012 Phone 4: (336)703-8550 �ddress/Road #: Subdivision: Sawgrass 139 Sawgrass Drive Advance INC 27006 Structure: SINGLE FAMILY. # of Bedrooms: 4 # of People: 'Water Supply: PUBLIC FE Classification: Provisionally Suitable SeproliteSystem? OYes ©No Design Flow: 4 8 0 Soil Application Rate: 0 3 'System Classification/Description: 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines 5 Total Trench Length: Trench Spacing: Trench Width: 1.6.0.0_Sq. ft. 0 3/.2 1/ a 0 a 1 perty Owner: MCDANIEL EMMANUEL and LYNN Address: 139 Sawgrass Drive City: Advance State/Zip: NC Phone #: QIP Phase: Lot: 292 Directions Hwy 158, tum right on 801, then turn right on Mocks Ch Rd. go to end then right, Development on right Minimum Trench Depth: D 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover. a 4 Inches 'Distribution Type: GRAVITY -SERIAL Septic Tank: Gallons 1 -Piece: Oyes ONO Pump Required: OYes QNo OMay Be Required Pump Tank: Gallons 1-Piece:OYes ONO 4 0 0 ft, GPM—vs— ft. TDH 9QFeet O.C. g lnches O.C. Dosing Volume: _ Gallons • 3 �Inches a Feet Grease Trap: Gallons Aggregate Depth: inches PreTreatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 Oil 0111 OIV Y CDP File Number 123663-2 County ID Number: E"s-000-0a292 ❑ Open Pump System Sheet ®Yes ONo ONo, but has Available `w-1 Trench Spacing:Inches 0.1 'Site Classification: Provisionally Suitable — 9 (9 Feet O.C. Trench Width: OInches Design Flow: 4 8 0 _ 3 e Feet Total Trench Length: 4 0 0 ft. Pump Required: Oyes ®No OMay Be Required PreTreatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is.allowed in areas designated forsystem 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 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 Improvettent Pemtit Issued (NCGS 130A -336(b)). If the Installation has not been completed during the period of validity of the Construction Permi; the Information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect; falsified "changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and maybe suspended or revoked (.1937(8)). 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/ a 1/ a 0 1 6 Authorized St a n . /�O Malfunction Log OYes « Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 Depth: SoilAggregate Application Rate: 0 3 inches _ Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR480 GPD OR LESS) Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 *Proposed System: 25%REDUCTION Inches Maximum Soil Cover: a 4 Nitrification Field 1 6 0 0 Inches Sq. ft. No. Drain Lines 'Distribution Type: GRAvrrY-SERIAL 5 Total Trench Length: 4 0 0 ft. Pump Required: Oyes ®No OMay Be Required PreTreatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is.allowed in areas designated forsystem 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 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 Improvettent Pemtit Issued (NCGS 130A -336(b)). If the Installation has not been completed during the period of validity of the Construction Permi; the Information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect; falsified "changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and maybe suspended or revoked (.1937(8)). 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/ a 1/ a 0 1 6 Authorized St a n . /�O Malfunction Log OYes « Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 C CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 T111"%Vina lirrowinn T%IMc' P.nnefrnrfinn Ai ifhnri�nfinn CDP File Number: 123663 - 2 County File Number. 129-000.00-292 Date: 03/21/a016 W W O Inch Scale:. . .OBlock SOME _ ddibt=.L. + ■■ME■ ■E■ MEN No MEN■ ■ MMEEMMM■■MM MEN SEEM ■������ ■■■ MOM ■■■E ■MSM No ■ M 0i°i■■ - ME ■■■ ■■■ No ■■■ ■■■ ■■■ MMMM No ■ ■M M _- mom MMM MMM ■■■! M ■ M■ ME MOM ® i MMM ■M■MMMMM MEM■EEM MMM ■ MMM MMM ME�� M��■�MM ■MMME M ME M MMMME! MMM ME EM ONE M, I0NIEMEMOMMEMEMEMOMMONNNEON : CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 123663 - 2 County File Number: E9-000-00-292 Date: 03/ 2 1 / 2 0 1 6 Click below to Import an Image from an external location: Drawing Type: Construction Authorization E q6 Davie County Health Department Environmental Health Section RECEIVED ue:2 Zla Zolfo P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 PAID Date: 2)210 J to Received by - Phone: (336) - 753.6780 Fax: (336) - 753-1680 ON-SITE WASTEWATE TIFICATION (Check One) Replaeemen emode mg Reconnection Name: �riirorl ��/2E,vst�2Gufes Phone Number 73G-'703-PS3z7 (iietne) Ne Mailing Address: 14REo ✓/ �lsv i /dam 3XG-Z'/S-Aoe (Work) C�NJinwr - Al -e A2 /.Z Email Address: S}t?tIC,�M1G�i U,IIeC ire e,rou�,Gow Detailed Directions To ot,,24. — 6eeL al 72• Property Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: �S�/���/ do 5 Type Of Facility: Date System Installed (MonflMate/Year): Number Of Bedrooms: ? Number Of People.--l— Is eople: Is The Facility Currently Vacant? Yes GE)If Yes, For How Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: POO 1 Number Of Bedrooms: Number of People Pool Garage Requested By: Date Requested: (Signature) For Environmental Health Office Use Only proved Disapproved I Environmental Health ?--a (—/& *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 Check Money Order Paid By: Account Invoice #: I�� re s P4 ROY- 6W 0(�&W %�/� DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003765 Tax PIN/EH #: 5871-25-2458.33 Billed To: Oak Valley Associates Limited Partne Subdivision Info: Oak Valley Lot # 33 Reference Name: Location/Address: Oak Valley Boulevard -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: h I27��s 1126//2 -191) Water Supply: On -Site Well Community Public 71 Evaluation By: Auger Boring Pit Cut FACTORS : 1 2 Y4 5 6 7 Landscape position L L; . Slope % HORIZON I DEPTH d _ p p Texture group ConsistenceP_SSsp Pro - Structure Mineralogy� p HORIZON H DEPTH Texture group Consistence' Q ... Structure Mneralogy HORIZON IH DEPTH Texture groupC Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence t rSS Structure ASk Mineralogy SOIL WETNESS ` RESTRICTIVE HORIZON.. SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE' SITE CLASSIFICATION: QS EVALUATION BY: 3 LONG-TERM ACCEPTANCE RATE O OTHER(S) PRESENT. REMARKS:. _ .... _- LEGEND Landscape Position R -Ridge S - Shoulder L - Linear slope FS -,Foot slope N - Nose slope CC -Concave slope, CV Convex slope T - TerraceFP - Flood plain H - Head slope r' Textures S - Sand LS - Loamy sand SL - Sandy loam L Loam SI - Silt SICL - Silty clay loam - SIL - Siltyloam - CL - Clay loam SCL Sandy clay loam SC - Sandy clay SIC - Silty clay C -. Clay CONSISTENCF.. maw VFR Very friable FR Friable FI -'Firm VFI Veryfirm EFI - Extremely firm 3Yst . NS - Non sticky' SS - Slightly sticky S - Sticky: ' .VS - V• erySticky i NP - Non plastic ' SP - Slightly plastic:. • P - Plastic VP - Very plastic'. -,.F Structure - SCK Single alar b1ocM Massive PivPlat CR - Crumb ... GR- Granular ABK - Angular blocky Single grain g ky y - PR - Prismatic - i Mineraloev ' _ .. -. • - _ 1:1; 2:1, Mixed i Horizon depth - In inches Depth of fill ; In inches Restrictive horizon -. Thickness and inches'from land surface _ Saprolite - S(suitable), U(unsuitable) _ Soil wetness - Inches from land surface to free water or inches from land strface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 ` - DCHD 05105 (Revised) �. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003765 Tax PIN/EH #: 5871-25-2458.32 Billed To: Oak Valley Associates Limited Partne Subdivision Info: Oak Valley Lot # 32 Reference Name: Location/Address: Oak Valley Boulevard -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS lit 2 3 4 5 6 ,7 Landscape position Slo %a . HORIZON I DEPTH Texture grou Consistence ... Structure AP, cc Mineralogy HORIZON R DEPTH Texture group Consistence Structure _SAL - Mineralogy HORIZON III DEPTH Texture group. _ kS r Consistence S Structure Mineralogy HORIZON IV DEPTH -72-: Texture groupr Consistence Structure .Mineralogy SOIL WETNESS i.- RESTRICTIVE HORIZON - SAPROLITE - CLASSIFICATIONids -'• . LONG-TERM ACCEPTANCE RATE ' _ SITE CLASSIFICATION: pS 'EVALUATION N BY: ' - LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS , LEGEND Landscape Position R -Ridge S - Shoulder-, ..L - Linear slope., . FS - Foot slope N - Nose slope CC -Concave slope, CV -Convex slope ' -T-Terrace FP - Flood plain H - Head slope, Texture y SICLnSilt clay loam sSII, -SfSL - Sandy loam' L Loam'- SI Silt Silty y lty loam CL'- Clay loam SCL Sandy clay loam SC = Sandy clay ., ; SIC - Silty clay •. 'C - Clay CONCICTFNC' `. - J VFR -Very friable . FR - Friable FI -. Firm _VFI -Very firm EFI -Extremely fum,. NS - Non sticky SS - Slightly Myst r y sticky S - Sticky' VS - Very Sticky NP- Non plastic " SP - Slightly lastic P gh Y P P - Plastic VP - Very plastic' 'Structure SC - Single grain M - Massive CR Crumb GR - Granular. ABK - Angular blocky SBK - Subangular blocky PL - Platy PR Prismatic Mineralogy: ' 1:1, 2:1. Mixed NDka Horizon depth - In inches Depth of fill - In inches i Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness -Inches from land surface to free water or inches from land surface• to soil colors with chroman or less ClassiLTARf Long-term acceptance rate - g�a y table), U(unsuitable) DCHD 65105 (Revised)