107 Coventry LnCONSTRUCTION
AUTHORIZATION
Davie County Health Department
210 Hospital Street
§` s P.O. Box 848
ih 6nuW
Mocksviile NC 27028
Phone: 336-753-6780 Fax: 336-753-1680 0 3/ 1 8/ a 0 a 1
Applicant: Lee Reich Property Owner. Lee Reich
Address: Address:
City: City:
StatefZip: NC State/Zip: NC
Phone #: Phone #:
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
107 Coventry Lane
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 601 South on left past Hwy 801 intersection
# of Bedrooms:
# of People:
'Water Supply: NIA
- System Specifications
Minimum Trench Depth: a 4
C
n: ProvisiohallySuttabte triches
? Oyes_,�No Minimum Soil Cover. 1 a Inches a 4 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:
Septic Tank: Gallons
*Proposed System: 1 -Piece: QYes ONo
Pump Required: QYes ONo OMay Be Required
Nitrification Field 8 7 3
Sq, ft. Pump Tank:- Gallons
No. Drain Lines 3 1 -Piece: QYes ONo
Total Trench Length: a 1 8 g GPM—vs-- ft. TDH
Trench Spacing: Inches O.C.
9 . @Feet O.C. Dosing volume: Gallons
Trench Width: _ 3 Inches _
Feet Grease Trap: Gallons
Aggregate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -II
Septic Tank Installer Grade Level Required: 01011 O III ON
CDP File Number 228340-1
*Site Classification:
Design Flow:
Soil Application Rate: u
`System Classification/Description:
*Proposed System:
Nitrification Field
No. Drain Lines
Total Trench Length:
County ID Number:
❑ Open Pump System Sheet
OYes ONO ONO, but has Available Space
Trench Spacing:— Inches O.C.
8Feet OC, Inches
Trench Width:Inches
0 Feet
Aggregate Depth:
inches
Minimum Trench Depth:
Minimum Soil Cover.
Maximum Trench Depth:
Maximum Soil Cover:
Sq. ft. `
*Distribution Type:
Pump Required: OYes
ft.
Pre -Treatment: ONS F
Inches
Inches
Inches
Inches
ONO (May Be Required
OTS -1 OTS -II
*S(te Modifications
No grading or construction activity is allowed in areas designated for system 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 Improvement Permit issued (NCGS 13t1A-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 incorre4 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, maintenancA monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? OYes ONO
Applicant/Legal Reps. Signature: Date:. /
2140-Nations,Rober 0 7/ 1 8 0 1 6
*Issued By: .Date of Issue:....
Authorized State Agent: Malfunction Log OYes
OO Hand 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
Drairrin� Drawing Type: Construction Authorization
CDP File Number: 228340 - 1
County File Number:
Date: 07/16/2016
W ^
O Inch
Scale: OBlock
()N/A
CONSTRUCTION AUTHORIZATION
Davie County Health Department
214 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 228340 -1
County File Number:
Date:.07/ 18 12015
Click below to import an image from an external locations: Drawing Type: Construction Authorization