171 Center Circle Lot 19--- - .--I
CONSTRUCTION
AUTHORIZATION
Davie County Health Department
21.0. Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: James F Dobson
Address: 171 Center Circle
City: Mocksville
State/Zip: NC
Phone #:
Address/Road #:
171 Center Circle
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms:
# of People:
*Water Supply: NIA
0 1/ a 0/ a 0 a 0
r. James F Dobson
Address: 171 Center Circle
Gity: Mocksville
27028 StatefLip: NC 27028
Phone #:
Subdivision: Shefield Park Phase: Lot: 19
Directions
Hwy 64 West, pass Sheffield Rd, next road on right
Center Circle, home will be on right
Minimum Trench Depth: a 4
Site Classifioation: Provisionally Suitable Inches
Saprolde System? QYes *No Minimum Soil Cover. 1 a Inches
Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 a 7 5 Maximum Soil Cover a 4 Inches
*System Classification/Description: *Distribution Type:
TYPE it A. CONV SYSTEM (SINGLE-FAMILY OR480 GPD OR LESS) Septic Tank:
Gallons
*Proposed System: 260%REDUCTION 1 -Piece: Oyes ONO
Pump Required: QYes ONO 0 May Be Required
Nitrification Field 1 3 0 9 Sq. ft. Pump Tank: Gallons
No. Drain Lines 3 1 -Piece: Oyes ONO
Total Trench Length: 3 a 7 ftGPM vs— ft. TDH
Trench Spacing: _ 9 (finches O.C.Feet O.C. Dosing Volume: _ Gallons
�
Trench Width:Inches
_ 3 - ,)Inches
Grease Trap: Gallons
Aggregate Depth: inches Pre Treatment: ONS.F OTS -11 OTS -ll
\ SepticTankinstallerGradeLevel Required'. 01011 0111 ON
CDP fille Number 187722 - 1
*Site Classification:
Design Flow:
Soil Application Rate:
'System Classification/Description:
'Proposed System:
Nitrification Field
No. Drain Lines
County ID Number, H2.050.80-007
❑ Open Pump System Sheet
OYes ONO ONo, but has
Trench Spacing:_
OInches
O Feet 0
Trench Width:(�
Inches
_ Feet
Aggregate Depth:
inches
Minimum Trench Depth:
Inches
Minimum Sol Cover.
Inches
Maximum Trench Depth:
Inches
Maximum Soil Cover: Inches
Sq. ft.
'Distribution Type:
TotalTrenoh Length: Pump Required: Oyes ONo OMay Be Required
tt
Pro -Treatment: ONSF OTS -1 OTS -II
"Site Modifications
No grading or construction activity is allowed in areas designated for system and repairwlhout approval of Health Department -
"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 forchecking with appropriate governing bodies in meeting their requirements.
This Authorization for WastewaterSysten Construction shall bevalld fora person equal to the period of validity ofthe ImprovementPermit not
to exceed five years, and may be Issued atthe sanetime the improvement Permlt issued (NCGS 130A -336(b)} If the installation has not been
com piked 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 besuspended 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, malntemanc% monitoring, reporting and repair
Applicant/Legal Reps. Signature Required? OYes ONO
Applicant/Legal Reps. Signature: Date:.
,Issued Bv: 2140 -Nations, Robert Date of Issue:. 0 1/ a 0/ a 0 1 5
Authorized State Agent. Malfunction Log OYeS
®Hand Drawing Oimport 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: 187722 -1
County File Number: H2•oso•Bo-007
Date: e 1/ 2 0�/ a 0 1 5
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