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DocuSign Envelope ID:81 E05E8E-EED7-43D3-8B8A-0811 OE72140A <br /> Orange County Health Department <br /> 1 131 West Margaret Lane <br /> (919)245-2360 ORANGE COUNTY Suite 100 <br /> (919)644-3006(FAX) NORTH CAROLINA P.O. Box 8181 <br /> Hillsborough, NC 27278 <br /> Construction Authorization <br /> PIN: 9867419070 Property Address: 3605 WALNUT GROVE CHURCH RD <br /> Application Date: 9/16/2020 3:31:26PM HILLSBOROUGH <br /> NC 27278 <br /> Permit Number: CA20-0304 Township: CEDAR GROVE-2 <br /> Applicant: ORANGE COUNTY SOLID WASTE Owner: ORANGE COUNTY <br /> PO BOX 8181 <br /> HILLSBOROUGH NC 27278 <br /> Phone: 919-682-7885 Phone: <br /> Email: bwoody@orangecountync.gov Email: <br /> Description: SE/S SR 1101 AKA WALNUT GROVE CH Lot Size: 18.13 Acres <br /> RD <br /> Water Supply: Private Well IP Number: IP20-0285 <br /> Facility Type: Business/Professional IP Expiration Date: 10/06/2025 <br /> SYSTEM SPECIFICATIONS <br /> Wasteflow: 100 GPD Accepted System Line Length(ft): 125 <br /> No.of Bedrooms: Nitrification Line Length(ft): 167 Initial System Classification: IIIb: Pump System <br /> Septic Tank: 1,000 Nitrification Line Width(ft): 3 Repair System Classification: Illbu: Pump <br /> (Ultra-Shallow) <br /> Min. Pump Tank: 1,000 Max Trench Depth(in): 24 Horizontal Trench Separation(ft): 9 <br /> Other: Existing Tank may be used as a septic tank if meets capacity, 1000 gals, has baffle and Tee with filter. <br /> COMMENTS: <br /> 1. PRESSURE MANIFOLD REQUIRED(see attached design by LSS) <br /> 2. EH General Condition-CA is issued per a NCSL 2018-114 submission by an LSS. <br /> See attached septic field layout by licensed soil scientist. <br /> PERMIT CONDITIONS <br /> REFER TO THE ATTACHED SITE PLAN SHOWING THE SYSTEM AND FACILITY LOCATIONS AND OTHER SYSTEM <br /> SPECIFICATIONS <br /> THIS AUTHORIZATION SHALL BECOME INVALID AND/OR MAY BE REVOKED IF: <br /> * THE INFORMATION SUBMITTED ON THE APPLICATION IS INCORRECT, FALSIFIED,OR CHANGES. <br /> • THE SITE IS ALTERED,OR <br /> * THE SYSTEM INSTALLATION IS NOT COMPLETED BEFORE THE EXPIRATION DATE. <br /> THE SYSTEM SHALL BE INSTALLED IN ACCORDANCE WITH: <br /> * ORANGE COUNTY RULES FOR WASTEWATER TREATMENT AND DISPOSAL SYSTEMS AS ADOPTED BY THE <br /> ORANGE COUNTY BOARD OF HEATH <br /> * ORANGE COUNTY WASTEWATER SYSTEM SPECIFICATIONS,AND OCHD POLICIES. <br /> SYSTEMS WITH A CLASSIFICATION OF III OR HIGHER WILL REQUIRE PERIODIC INSPECTIONS BY THE O.C. HEALTH <br /> DEPARTMENT <br /> ISSUED: 10/23/2020 EXPIRES: 10/23/2025 <br /> John Davis <br /> Environmental Health Specialist <br /> PM_EG_EH_ConstructionAuthorization 2020.10 <br /> Report created:10/22/2020 6:27:45PM <br /> Page 1 of 2 <br />