122 Westridge Road Lot 36CONSTRUCTION
AUTHORIZATION
d = '� Davie County Health Department
210 Hospital Street
., ,. P.O. Box 848
Mocksville NC 27028
For Office Use Only
*CDP FileNumber 202164-1
County ID Number:
Evaluated For. REPAIR
�, Township:
PERIAIT VALID UNTIL -
Address/Road #:
122 Westridge Dr.
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
*Water Supply: PUBLIC
Subdivision: Westridge
Phase: Lot: 36
Directions
Hwy 158 e, right on Hwy 801 South, tum right on Hillcrest
right on Westridge
System Specifications
Phone: 336-753-6780 Fax: 336-753-1680
0 3/ 3 1/ a 0 a 1
Applicant:
Jane McKee
Property Owner:
Jane McKee
Address:
122 Westridge Road
Address:
122 Westridge Road
City:
Advance
Maximum Trench Depth: 3 6 Inches
Cay:
Advance
StatefZip:
NC 27006
*System Classification/Description:
StatefZip:
NC 27006
Phone #:
(336) 978-0909
Phone #:
(336) 978-0909
Address/Road #:
122 Westridge Dr.
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
*Water Supply: PUBLIC
Subdivision: Westridge
Phase: Lot: 36
Directions
Hwy 158 e, right on Hwy 801 South, tum right on Hillcrest
right on Westridge
System Specifications
Dano l of z
Minimum Trench Depth: a 4
Site Classification:
Provisionally Suitable
Inches
Saprolite System?
QYes QNo
Minimum Soil Cover. 1 a Inches
Design Flow:
3 6 0
Maximum Trench Depth: 3 6 Inches
Soil Application Rate:
0 2 7
5
Maximum Soil Cover: a 4 Inches
*System Classification/Description:
*Distribution Type: GRAVITY -SERIAL
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
_ Gallons
*Proposed System: 25% REDUCTION
1 -Piece: O Yes O N o
Pump Required: QYes QNo OMay Be Required
Nitrification Field
1 3
0
9 Sq. ft. Pump Tank: Gallons
No. Drain Lines
4
1 -Piece: CYes ONo
Total Trench Length:
3 a 7
ft
GPM—vs-- ft. TDH
Trench Spacing:
_
9
2 Inches O.C. Dosing Volume: _ Gallons
Feet O.C.
Trench Width:
3
Q Inches
Feet
_
Grease Trap: Gallons
Aggregate Depth:
inches
-
Pre Treatment: ONSF OTS -1 OTS -II
Septic
Tank Installer Grade Level Required: 01011 07111 ON
Dano l of z
CDP File Number 202164 - 1 County ID Number:
Repair S
❑ Open Pump System Sheet
Required:OYes 4No ONo, but has Available Space
._..�_.. Trench Spacing:8Feet
Inches 0.1
*Site Classification: Provisionally Suitable — O.C.
**** 15A NCAC 18ftwII1945 **** gee les
Design Flow:
Soil Application
Depth:n Rate: inches
*System Classification/DescriRe*pair
Minimum Trench Depth:
Inches
Area Exem,,Rt—
Inches
Maximum Trench Depth:
*Proposed System: Inches
Maximum Soil Cover:
Nitrification Field Sq. Inches
ft.
No. Drain Lines *Distribution Type:
Total Trench Length: ft Pump Required: OYes ONo OMay Be Required
\ Pre 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. i
*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 Improvement Permit issued (NCGS 130A -336(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 maybe 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, Robe
Date of Issue:. 0 3/ 3 1/ x 0 1 6
Authorized State Ager>t� / Malfunction Log Oyes
01 -land Drawing Olmport 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: 202164 -1
County File Number:
Date: 03/31/016
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Scale: OBlock
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1)
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 202164 -1
County File Number:
Date: .0.3 / 3 1/ 2 0 1 6
Click below to import an Image from an external location: Drawing Type: Construction Authorization
DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST (�
APPLICATION IP/ATC OSWW REPAIR
w e'e
Name
Telephone Number
Address
Mailing Address (if different from above)
Email Address:
Subdivision NJame g.5//- e�
3' Lot #
Directions f7 w
GL/ 0CdA- /il &0-
6k-Date System Installed
Name System Installed Under
Type Facility
Number Bedrooms Number People Served
T e///7Water S
e/cific Problem Occurring x211 l p[�GY`� G�i('P
///�1�ply
C
Date Requested
Info Taken By 028.
THIS IS TO CERTIFY THAT THE INFORMATION
PROVIDED IS COIRRPCTtO 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 /
(ROOI
Revisit Charge Date
Reason
Revised 2-2011
DAVIE COUNTY HEALTH DEPARTMENT.
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR:- /1'TR("yC cmn�S`� C�D�';; DATE /& k PERMIT
LOCATION U nJOPPAS's •, W. %oZa WeS�r�al��, N9 1197
S.R. NO.
SUBDIVISION NAME lkjczl+*'J210- LOT N0. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS; NO. BATHROOMS',' Two Bedroom House 800 Gala 600 Sq. Ft.
GARBAGE DISPOSAL UNIT. YES ❑ NO. ❑ Three Bedroom .House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES- C3 NO t3Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. -WASH. MACHINE YES 0 NO ❑
SITE SUITABLE YES ❑ NO . ❑►"�'
SIZE OF TANK gal. 11
NITRIFICATION FIELD 41/S -p sq. ft.
DEPTH OF STONE IN LINESs
WATER SUPPLY: Individual-. Publici'- ❑
i�
IMPROVEMENTS PERMIT BY i" INSTALLED BY �atl►r CN.• eo.
CERTIFICATE OF COMPLETION By Date
V7 7
(8/16/73) *Construction must omply with all other applicable State and local regu ations
LOT AREA
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