HomeMy WebLinkAboutOP-1-10-4168.TIF i
OPERATION PE RM I fp' For Office Use Only
Catawba County Public Health Department *CDP File Number a 4 0 6 1
Environmentat Health Division G~ ADS` wLS2008-00428
P.0 Box 389, 100-A Southwest Blvd Sq'tig`t,1 County ID Number:
y' Newton NC 28658 Evaluated For: NEW - J
i
Phone: (828)-465-8270 Fax: (828) 465-8276
Applicant: JERRY AYERS Property Owner: JERRY AYERS AYERS TRUST
Address: 221 STANAFORD RD Address: 221 STANAFORD RD
City: WINSTON SALEM City: WINSTON-SALEM
State/Zip: NC 27104 State/Zip: NC 27104
Phone Phone
Property & Site Information _
Address/Road Subdivision: Phase: Lot: 1
8341 LONG ISLAND RD
CATAWBA NC Directions
Structure: SINGLE FAMILY **Revised 5/2/08 Address Corrected (djk)** JUST
BEFORE LONG ISLAND RD DEAD ENDS INTO
# of Bedrooms: 4 LAKE NORMAN/ PROPERTY IS ON THE RIGHT
# of People: 2 SIDE/ SURVEYOR-S STAKES AND PLASTIC
*Water Supply: NEW WELL RIBBONS ON TREES MARK PROPERTY
r+~~ ire n r~rr~
*IP Issued by: 2246 - Megen McBride *System Classification/Description:
TYPE III E. PPBPS GRAVITY DOSED SYSTEM
*CA issued by: 2246 - Megan McBride
Design Flow: 4 8 0 *Distribution Type: GRAVITY - PARALLEL (eq. d-box
)
Soil Application Rate: 0 3 5 *Pre-Treatment:
Drain field
rNitrification Field Sq. ft. *System Type: PPBPS
rain Lines 5 Installer: Shannon Henderson
Total Trench Length: a 3 0 ft. Certification 1091
Trench Spacing' - 8 0Inches O.C.
&)Feet O.C. *EHS: 2246 - Megen McBride
Trench Width: a Olnches
- OFeet
Aggregate Depth: inches
Minimum Trench Depth:
Inches
Minimum Soil Cover: Inches Approval Status
Maximum Trench Depth: Approved ❑ Disapproved
Inches
Maximum Soil Cover:
Inches
cur rue Number Se ti c Tank county lu Numper:
Manufacturer: TP Lat.
STB: 1012 Long:
Gallons: 1000 Installer: Shannon Henderson
Date: Certification 1091
*Filter Brand: POLYLOK PL-68 *EHS: 2246 - Megen McBride
ST Marker: S Yes ❑ NO Approval Status
Reinforced Tank: ❑ Yes ❑ No R Approved El Disapproved
1 Piece Tank: ❑ Y2S ❑ NO
Pump Tank
Manufacturer: Installer:
PT: Certification
Gallons: *EHS:
Date: Approval Status
Riser Sealed ❑ Yes ❑ No ❑ Approved El Disapproved
Riser Height: ❑ Yes ❑ NO (Min. 6 in.)
Reinforced Tank: ❑ Yes El NO
l Piece Tank: F1 Yes 11 NO
Supply Line
Pipe Size: inch diameter Installer:
Pipe Length: feet Certification
*Schedule: *EHS:
Pressure Rated ❑ Yes ❑ NO
Approval Status
Approved fittings ❑ Yes ❑ No ❑ Approved El Disapproved
Pump Requirement
Pump Type: Installer:
Dosing Volume: - Gal Certification
Draw Down: Inches *EHS:
*Chain: Approval Status
Valves Accessible ❑ Yes ❑ No ❑ Approved O Disapproved
Flow Adjustment Valve ❑ Yes ❑ NO
Check-valve ❑ Yes ❑ NO
PVC Unions ❑ Yes ❑ No
Vent Hole ❑ Yes ❑ NO
Anti-siphon Hole ❑ Yes ❑ NO
CDP File Number 24061 County ID Number: wLs2oos ooa2a
Electric Equipment
r`NEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer:
Box 12 inches Above Grade El Yes El NO
Certification
Box Adj. To Pump Tank ❑ Yes ❑ NO
Conduit Sealed ❑ Yes ❑ NO *EHS:
Pump Manually Operable ❑ Yes ❑ NO
us
*Activation Method: Approval Stat
❑ Approved ❑ Disapproved
Arm Audible ❑ Yes ❑ NO
~.Allaa rmVisible ❑ YeS ❑ NO
2246 - Megen McBride
*Operation Permit completed by:
Authorized State Agent: ftsil-11 K G Date of Issue: 0 9 a 9/ a 0 0 9
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 et. Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE iii E. Sewage septic system.
Rule .1961 requires that a Type TYPE iii E. septic system meet the following criteria:
Minimum System Review By The Local Health Department: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator for the life of the septic system.
Rule .1961 requires that Type VI septic systems designed for a 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 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 for maintenance 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.
'O Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Total Time:(HH:MM)
0 0 Hours 0 0 Minutes
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CDP File Number: 24061 County File Number: WLS2008-00428
Drawing Type: Operational Permit Date: 0 9 9 x 0 0 9
Q Inch -
Scale: 0 Block
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