Loading...
145 Armsworthy Rd HEALTH DEPARTMENT RELEASE For office use Only *CDP File Number 218609- 1 �Ty Davie County Health Department - 210 Hospital Street County ID Number. P.O. Box 848 HDR/WWC Evaluated For:. Mocksville NC 27028 Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID 0 5 / 1 2 / 2 0 2 1 UNTIL Applicant: Tim Sharron/Triangle Pools Property owner. Tim McCulloh ress: 701 Easly Rd Address: 145 Armsworthy Rd City: Eden City: Advance State2ip: NC 27288 State2ip: NC 27006 Phone#: (336)344-6469 Phone#: Property Location&Site Information Address 145 Armsworthy Rd �- Subdivision: Phase: Lot _ ._Road# Advance-- -- ----NC 27006 -- SINGLE FAMILY, Township: 'Structure: Directions #of Bedrooms - #of People: Hwy 158 East,right on Armsworthy Rd.on the left 'Water Supply: NIA Basement: n Yes❑No Type of Business: Total sq.Footage: No.Of Employees: _'Proposed Improvement: Pool *R* leasendhions ` tly staked,pool must be moved toward the back of the house 5 feet to meet 15 foot setback 1 G This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps.Signature Required? Oyes ONO Applicant/Legal Reps.Signature,• *Date: *Issued By: 2140-Nations,Robert *Date of Issue: 0 5 1 a ` .2 0 1 6, Authorized State Agen **Site Plan/Drawing attached.** ®Hand Drawing Olmport Drawing HEALTH DEPARTMENT RELEASE 218609 - 1 j� d.,sq, Davie County Health Department CDP File Number. K �� 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 05 / 1 2 / .10 1 6 Inch Scale: O Block = ft. Drawing Type: Health Department Release ON/A rfii � liiilllllllllll ( III 1.1001 I f i f f � fI 7�1 I I L I i I f f I of Page 2 of 2 Davie County Health Department 1836 � Environmental Health Section °= P.O.Box 848 210 Hospital Street ' Tj 0 Courier#: 09-40-06 n�1 U Mocksville,NC 27028 h. Phone:(336)-753-6780 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: lI 14 / 0A) !/ a/(/ le-J0 Phone Number 3 3 'lD (Home) Mailing Address: G/� & 3-6!7V7_(Work) e/j Email Address: AM�_WLJ J14 �A Detailed Directionsnbe: 0A1N� D Property Address: 74,45 Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: 1• 44C&1t0A Type Of Facility: SLS Date System Installed(Month/Date/Year): �7 9 9 Number Of Bedrooms: •Number Of People: Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes 001f Yes,Explain: Please Fill In The owin Information About The NEWFacility: Type Of Facility: (�dam' Number Of Bedrooms-__-0— Number of Peopfe� 'Pool Size: 32— h Garage Size: Other: Requested By: - Kate Requested6� � (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment: Cash hec Money Order # Amount:$ Date: ,6 Paid By: Received By: Account#: Invoice#: y,f,-.(:i' Y �� ,r'"S..r-��- 10 ,_�„..,st t-', r .F.. a^4 r;'Y:' . '1N,r'. - ._.*.�<< _ ♦,_ A . .�.`v -sr..� + .'Y-ii a w1=`. ,.r.,,♦ Y :.,'.�:;s� AOTHOTIZATION NO: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee... ' P.O.Box 848 "Names � � �/ � Mocksville,NC 27028 Subdivision Name: xs Phone#:704-634-8760 Directions to property: . Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#�tf - - SYSTEM CONSTRUCTION . Road Nam **NOTE**This Authorization for Wastewater.System Construction MUST BE ISSUED.by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTALHEA�1 SLTI PECIALIST DATE ISSUED �„i(•" �'y -''„�L .� �� "".rK.-`_x..�'[-r\+r'-:.:.:tr..t ..:i._+.+,.�.v}�s.t . "Y.a,:".,•,.. . . a w-�. ...+w<axe-.,c--•:.-.s..'-^�:.�.-"wti...; ,,,d..n.-. : ...,-._ .��� e _tom .+r•,. DAVIE COUNTY HEALTH DEPARTMENT A, 13' ' iI ROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION rermlttee 41; • �f.. /( � �IT4 Subdivision Name: Directions to property: ,f 1/'/�1:-�' t".�.rfn� (C� Section: Lot: rf I!WPPROVEMENT PERMIT Tax Office PINA2.�W - - Road Namep **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system:An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained.from this Department prior to the construction/installation of a system or the issuance of a building permit. r (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ` •tee' . , ,'f ;/ + `,; PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH'SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE PIIS PERMIT BEFORE INSTALLING THE SYSTEM.I RESIDENTIAL SPECIFICATION:BUILDING TYPE /54 #BEDROOMS ✓T #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPEell, #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZB'C,�/R"40TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ZXGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ”*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. OPERATION PERMIT - SYSTEM INSTALLED BY: AQ1% 110 , Ito i AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS DESC D ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATME DI SAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY G PERIOD OF TIME. _ DCHD 05/96(Revised) 2.I •.f.t R. • - 4y \ ) AJ'PLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT &ATC " Davie County Health Department Environmental Health Section P.O.Box 848 D;� Mocksville,NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. � l 16�1. NametobeBilled—\ 'Mr4M c- U�1y h Contact o Mailing Address La 66� YS H�,ly S43 Home Phone /do— TI City/State/Zip &n G'..i N.C�I �?Qd 6 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: [-J'H-ouse [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People _ #Bedrooms #Bathrooms_ [,t191-shwasher[]'Garbage Disposal [-]-Washing Machine [--�sement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other:Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats._ Estimated Water Usage(gallons per day) 7. Type of water supply: M County/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes N No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**tWFM OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: .2.Sd X 3- WRITE DIRECTIONS(from Mocksville))TO PROPERTY: Tax Office PIN: # �- _-Z_ 6 Property Address: Road lame 1 f M W D i IS 6 city/Zip �.V Q)N6 n 1 e;4 . e iQ tvL� & Db If in Subdivision provide information,as follows: b ll5 W 1!1 6 t Name: ; Section: Lot#: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I, also,understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by //'V11 ftCC VA to t all testing procedures as necessary to determine the site suitability. DATE —\c�1'—_l SIGNATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAW I N '1 OUR SITE PLAN: Z63 LH ED lfr It/b Mit - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED 4 PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME �G'/�15''/i✓d y Y L. Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE �( SITE CLASSIFICATION: U J EVALUATION BY: G LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD(01.90)