Loading...
325 Ben Anderson Rd DAVIE COUNTY HEALTH DEPARTMENT Environmental Heaith Section , , ' ' ' P.O.Bog 848/210 Hospital Street G� 3�7�D Mocksville,NC 27028 � . � ' / (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001579 Tax PIN/EH#: 5802-45-9392 Billed To: John Hohmann Subdivision Info: Reference Name: Location/Address: Ben Anderson Road-27028 Proposed Facility: Residence Property Size: 3.974 acres ATC Number: 2719 **NOTE** This ImprovemendOperation Permit DOES NOT authorize the construction ofa 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(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type M �t #People 3 #Bedrooms 3 #Baths Z Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New❑ Repair� System Specifications: Tank Size /Op�GAL. Pump Tank GAL. Trench Width.3G�� Rock Depth /�t Linear Ft.ZO� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6`�BELOW FINISHED GRADE. ****NOTTCE: Contact a r r o t e Davie Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:0 .to 1:30 . e ay of7tistallation. Telephone#is(336)751-87G0.**** /' , � �, Environmental Health Specialist's Signature: Date: p���ZS�'Q� DCHD OS/99(Revised) ' . �Q/ .3- 7�/ . ' ' ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' ' � r.o.Bog sasnio x�p�t��st,��t Mceksville,NC 27028 (336)751-8760 Account #: 990001579 Tax PIN/EH#: 5802-45-9392 Billed To: John Hohmann Subdivision Info: Reference Name: Location/Address: Ben Anderson Road-27028 Proposed Facility: Residence Property Size: 3.974 acres ATC Number: 2719 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Gx%(�f Date: c�.c ��� �1 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 of G.S.Chapter 130A,Section .1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period oftime. i/ ���X /�' � Septic System Installed By: Environmental Health Specialist's Signature: Date:�— o� (O�v f DCHD OS/99(Revised) , . . - p � � � � M � . , ` � � APPLJCATION FOR SITE EVALUATION/IMPROVEMENT PEI�MI��c ATC � Davie County Health Department FE6 ! 4 ZOpI • ' Environmenta/Hea/tfiSection � P.O. Box 848/210 Hospital Street �_____�� Mocksville, NC 27028 EN''�'�'����"�,ici�17;;� (336)751-8760 D�i'ulE���,v yEl�tTH ***I1�ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nama to be Billed rl Contact Peraon Mailinq Addzesa �� p ��WCk..ti'`� ��'('k � Home Phone 7'7�—S.�/y�- City/State/ZZP 1 1 �OC'��S1�`I�le �t/c � /(���7 Husinesa Phone 3�0�—O 7oT 2. Name on Pezmit/ATC i£ Different than Above Mailinq Addreas City/State/Zip 3. Application For: �( Site Evaluation ❑ Improvement Permit/ATC ❑ Both a. syHtem to se=vice: ❑ House J�' Mobile Home ❑ Business 0 Industry ❑ Other 5. Zf Residence: � People �_ R Bedrooms �_ A Bathrooms �_ f_1 Dishxasher ❑ Garbage Disposal ❑ Washing Machine O Basement/PlumY�inq ❑ Basement/No Plumbing 6. If Buainess/Induatry/Other: Specify type # People �k 3inka � Commodes / Shoxers i Urinals �F Water Coolera IF FOODSERVICE: # Seats Estimated Water Usage (gallona per day) �. Type oP water supply: ❑ County/City j� Well � Comaunity s. Do you unticipate additions or eapansions of the facility this system is intended to serve? ❑Yes �No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY 1NFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: � ., 6 l � �--� WRITE DIREGTIONS(Srom Mocksville)to PROPERTY: TaxOfficePIN: # 5`dDa-�45-Q�a C�01 Nar`1-� - /urn �c°f� PropertyAddress: RoadName_ '1,Cr1 �Y1det'S�VL (�v� �i��v �YIuV'c{� �a �� City/Zip �OC'_��S V►��c o�7��� ��-t-t' D`(�-}�� I�c�^ �v'e��< C� , If in a Su6division provide information,as follows: ��_ _ �i� ��` n� I)f.et t�y nC�^S�x _ ' �/i D � ���,� w�// Name: G{ P r� h-� 4 ��s an�so� .-w,rl Section: Block: Lot: DatePropertyFlagged:,..-- " � � n,�{--{a o/S r 1 ; 8' �...' 6ccrfL Th�s is to certify that the information provided is correct.to the best of my knowledge. I dcrstand t6at any pe�I A �cco . • rmit(s) ��/ l��ll� w�i��e. issued herea[ter are subject to suspension or revocation,if the site plans or intended use chunge,or if the mformation h�{ submitted in this applicatioa is falsified or changed I,also,understand that I am responsible for all charges incurred from thts applicalion. 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 to conduct all testing procedures as necessary to determine the site suitabili . DATE 2 13"' �� SIGNATURE _ � �/ ��...�-- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Eaisting and proposed property lines and dimensions, structures, setbacks, and septic locations). �0 �{� 5��s �`�� Site Revisit Charge • � ����,� Date(s): -2� r«-ti�' �ubbo,•s � Client Notification Date: ��� S�,ll,��- _ �,�r—�....� EHS: . `'� ,% t� Account Na �� ! � z -z, b 5 Revised DCHD(07/99) � , ) � ��,�,, Invoice No. �'"c, NP o 5S� �� �� � � �( , � . '-!, 71E-LINE . ' . . . '�>:>'46" W 724,93� IRON FOUND N 03°35'46"E 192.25' -► :;;� (NTS) •,:; I ;:7 . � � ;; '::; , � ;� � . ;, .. ,� . .� �.'j _. + . r � . ^ N �'� ^h ' `° � 3.974 Acres NDERSON A/W � � � 130, Page 21 �v � ,^� ^o � IRON FOUND 10g.51' � . ''S 11°pq., 10��w � sv cn � o M � rn 0 � , �' o CLARENCE C. � � Deed Book� 62, F �` o � � � IRON � j �11NE F UN .�� j w �9.$g' � ���� �S 16° . ��2��W RR SPK. �26� 2�, FOUND _ _ PP ,� OVERHEAD U71L TY L{At� IRON S �6°23� B 4�' w 269 12 0� � � E ' S N ANDERS N 02°44'41"E 168.66' --► •R. �32' p ON pOq D RR SPK. i� V, pUQ � � ' ' DAVIE COUN'I'I'HEALTH DEPARTMENT , .. '� � ' ` Environmental Health Section . Soil/Site Evaluation " APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001579 Tax PIN/EH#: 5802-45-9392 Billed To: John Hohmann Subdivision Info: Reference Name: Location/Address: Ben Anderson Road-27028 Proposed Facility: Residence Property Size: 3.974 acres Date Evaluated: �—�Z�,/ Water Supply: On-Site Well �� Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 .6 7 Landsca e osition ,[r Slo e% o� . HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH " '' Texture rou G Consistence � Structure 1C" Mineralo �' HORIZON III DEPTH Texture rou Consisfence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: � EVALUATION BY: 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 Mineraloev 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 DCF�ID OS/99(Revised) ■■�■���■■■�■�■■�■��■■����■■■���■■���■�■�■■��■�■■■�■■■���■■��■���■■ ■�■���■■�■��■■■�■�■■■�����■���■■■���■�■���■��■■���■■■■■■■�■■■��e■ ■■�����■�■�������■����■■■�■��■■���■■■■��■■��■■���■�■■■■������■�■■ ■����■�■■■���■■■��■�■■■■■■�����■ ■�■■■�����■�■■�■■■■■��■�����■�■■ ■■��■�■■���■�e�■es■�s�■■■�■■�■��■■��■�■■��■■��■�e■■■■��■■��■■�■�■■ ■■���■��■■�■��■���■�■���■��■■■■��■��■■■■��■■�■■��■�■■■■■���■��■■■■ ■��■��■■■■■�■■■����■�■��■■■���■�■■�■■�■■■■��■�■■e■o�■��■�■�����■�■ ■�■��■��■■■■■■■■���■��■■�■■�■�■��■■���■■■�■■��■��■��■��������■■■�■ ■■��■�■o��■■���■�■�■��■■����■�■��■■����■��■■�■■■�■■■■■■�■�����■��■ ■■���■■■■■�■■■�■�■■�■��■�■■��s■�■■■����■■■■■��■■■■�■■�■■�����■�■■■ ■�s�■s��■■s■■■�■�■■��■■■■���■■�■��■�■■����■�■��■■■�■�■�������■■■■ ■����■■■���■���■����■��■■�■���■■ ■■�■��■�■■■�■■��■�■■■■�■��■■■■■■ ■��������■���■��■�■■■���■�■■�■�■■��■����■■■�■��■��■�■■�■����■■■�■■ ■�■�■�■��■■��■■�■■�■�■��■■■■■���■��■����■■■��■�����■■■■■�■��■■■�■■ ■■■���■■��■■■■■■■■�■■■■■�■�■■�■■■■�■■■■��■■��■��■�■��■■■■■��■■■■�■ ■■������■�■■���■��■�■�■��■■�■�■��■��■����■■��■�■■�■■�w■�■■■�■■■■�■ ■��■����■���■■■�■�■�■��■��■�■����■■��■■■�■■�■■■��■■■�■■��■■��■■■�■ ■■■��■��■��■�■■����■���■■�■■������■��■■�■�■■�■e�■■■■■��■��■■��■■�■ ■■■��■���■■����■�■���■�■��■■�■�■�■■�■�■■�■■��■�■�■■■����■�■��■■�■ ■�■��■�■�■■■■�■■�■���■��■■■■���■ ■■�■�■■�■■����■■��■�������■��■■■ ■■��■�■■■�■■■■■■��������■■�■�■�■■�■■■■�■■�■■■■��■■�■■■■�����■■�■■■ ■�■��■■�■■■■■■���■����■��■�■■�■■■��■■��■■��■■�■�■■��■■■■■■■■�■�■■■ ■■■�■■■����■■■��■�■�■��■�■��■�■�■■�■■�■�■■�■��■��■��■■■■■■■■���■�■ ■■�■■�■�■■��■■■�■�■�■��■�■■�■�■■�■■�■■■e�■��■�■■�������■■■■■■�■�■■ ■��■��■��■■�■�■�■�■■�■�■��■■���■�■■��■■■�■��■��■��■���■■�■�■■■��■■ ■��■�■�■■■■���■■�■�■�■��■�■■�■�■■�■■��■■�■■���■■■�������■■�■■■■■■■ ■t■�■■■��t■■■��■���■■■■�■■�■���■�■■�■�■■■■����■■�■■�������■■■■��■ ■�■���■����■■���■�■���■�■■����■■ ■■�■�■���■���■■�■■■�■����■�■■�■■ ■■����■■■��■�■■■■������■�■�■■■■�■��■��■�■�■��■��■■�■■�������■■■■■■ ■■�■�����a���■��■���■A�■t■��■■■�■■����■�■■�■�■��■■��■■■■�����■■��■ ■■�■����■■��■■■�■���■�:�■■■��■■��■■�■■■■�■■■■■■����■�■■■■�■���■■■�■ ■■�■���■�■■���■■■�■■■■�■■�■■�■■��■■■■■■��■��■��■�■■�■■■■���■��■��■ ■■■�■■����■�■�■■�■�■�■■�■■�■�■�■�■■�■�■■�■����■■■��■��■�■■■■■■���■■ ■�■��■■���■■■■�■�■■�■■■e�■��■��■■�■■�■�■■■���■��■�■■■■■������■��■■ ■�■��■■�■����■�■������■��■�■■■�■�■■���■■�■r�■���■■�����■������■��■ ■■■■■�■■���■■■■�■�■�■�■■�■��■�■■ ■■■�.�■�■��■■�■■■■■�■������■■■■■ ■��■���■■■�■�■■�■�■■■�■■�■■�■■■�■■�■■■��■�■■��■�■■��■■■■��■�■■■��■ ■��■�■�■�■�■�■■�■�■■■■���■■�■�■�■■�■■�■�■■�■■■■�■■��■■■■����■■■■�■ ■�■■■■���■�■�■■e■�■■�■�■��■�■�■�■■■■■■■■■■��■�■��■■■�■■■�����■■■�■ ■�■��■■■�■■�■���■��■�■��■�■��■�■�■■���■_==�■��■■■��■���■■■■�■■�■��■ ■■�■�■■�■■��■�■�■■������■����====:::�■■■�����■�■■■■���■�■■�■■■��■■ ■��■�■■■����■���■■����■��■�����■■�■■����■��■■■■�■��■■■������■■���■ �iiiiii�iiiiii�iiiiiii�iiiiiiii�iiiiii�iiiiiii�iiiiiii�iiiiii� ■■�■������■���■■��■�■�■■���i�■���■■������■��■■�■■■■■�■■■■�����■■■�■ ■■�■���■■�■■���■�■■�■�■■�■�i�■■■�■■��■■■�■���■■■■■�■���■■■■�����■■■■ ■��■���■■�■■���■�■■�■�■■���i�■�■�■■■�■■■■■�i��■�■■��■���■■■■■����■�■s ■■■■���■■■�■�■�■■�■�■�s■■■�i■■■■■�■■�■�■■��i■����■■�������■���■■■■�■ ■■��■■��■■�■■■■�e■■����■���i■���■■�������o��■■�■■�■■�■■��■����■■■■■■ ■�■■�����■������■��■■�■■■��.�■����■�.::::�■■�■��■■��■■■■■�■���■��■ ■���■��■�■��■���■■�■�■■�■��■■■���■■■■��■��■■�■��■���■■■■■■�■��■�■ ■■��■�■���■■■�■■�■�■�■■��o�■�■■■ ■�■�■�■■�■■����������■■■■������■ ■��■■�■■��■■�■��■■■������■��■�■�■■��■■��■■�■■�■■�����■■■■■��■�■■�■ ■■�■��■■■�■■�■�■��ve■■■��■��■■■�■■�■■■■�����■�■■��■■��■■■■�■■■���■ ■■�■■�■■■■■■�■�■�■■�■�■■��■�■�■��■:�■■■��■■■�■�■■�■■�������������■ ■■�■■���■■�■����■�■�■■■■����■■����■■�■■■■�■�����■■�■■�■■�������■■■ ■��■�����■�■��■�■��■�■�■■��■�■�■��■■���■■�■■��■��■��■■■■■■������■■ ■■■��■����■■■■■�■��■■■�■��■■�■�■■�■��■�■■��■��■��■■�■■■■■■■■�■�■■■ ■■■��■■■■■■��■■����■■■■���■■■�■■�■■■■�■■���������■�■■■■■■��■■�■■■ ■�■��■■■�����■■�■�■■■■�����■���■ ■■�■�■■��■■�■�����■■■■■■■����■■■ ■�■�■■■��■��■■■����■�■��■��■�■��■��■■■��■��■��■■�■■����■■■■■���■�■ ■■■■■■■���■�■�����■■■■��■��■����■■�■■■��■■�■������■��■■�■■■�����■■ ■■■■����■■■■■���■■�■������■�����■■■■■�■��■��■��������■■�■■�■�����■ ■�■�■■■�����■■■■�■�■■�■��■��■■■■■■�����■�■���■■■■■■■■�■�■■�■■■�■■■ ■■��■��■■�■�■��■�■��■■■��■��■■■��■��■�■■�■���■■■■■������■■■■■■���■ ■■������■■■■■��■�■■�■■■■��■�■o■■�■■��■■■�■■■■■■��������■■■��■■�■�■ ■��■■■■■■■�■�■�■■�■�■■■■���■�■�■����■�■■�■■■■■■�■�■■��■■��■��■�■■ ■��■�■�����■�■■����■■■■■���■■■�■ ■■■■■■■■��■��■��■■■■■■■������■■■ ■�■������■■�■���■��■�■��■�■■���s■■■■�■�����■������■■����■■■■■��■■■ ■■����■�■���■�■■■■�■�■■■�■�■�■��■��■■���■■�■■�■■�■■���■�■■■■s■�■■■ ■■■■■■��■�■�■������■�■■■���■�■■■■■■��■■■■�■■■■�■■�■���■■�■■■■■���■■ ■�����■■■■�■���■�■■■■����■■�■����■�■■■■■■■�����■■�■■��■■��■�■■���■ ■�■■���■�■�■�■�■�■■�■�■■�■��■�■��■■�■■■■�■�����■■�■■����■■■■■■�■�■ ■�■��■■■����■■■■�■■�■���■■■�■������■■■■■�■�■■■■�■�����■�■■■■■■■��■ ■■■■■■��■�■e�■■�■�■��■�■■���■■■■�■■��■��■■���■�■��■�■■��■���■�■�■ ■■■■■■�■�■���■■■■■■■■����■■■■■■■ ■��■■■■■■■■■■■■��■■���■�����■■�■ ■������n�■■�����������■■����■����■�■�■■■����■�■■���■■■■■■�■■■■��■ ■�����■■■�■���■����■�■■����■■■■■�■��������■■■���■���■�■■■■��■��■■■ ■■���■��■■■�■■■����■�■�����■■■■■■■�■�■■�■■■�■����■��■��■��■■��■�■■ ■■��■■���■■■■■■■■�■■�■�■■■■■�■■�■��■�■■�■■��■�■■■�■�■■�■■■■�■�■�■■ ■������■■■■����������■■■��■■�■�����■■■■���■����■��■■■■■■■■■■■■���■ ■■■■■■����■■■■■■■■■■��■■■�■�■■■■■�■����■�■■■■����■■�■■■������■■■�■ ■��■�■���■■■■�■■�■■��■■■■■■■�■�■���■■■■■�■■■�■�■����■■■■■■■��■■�■ ■�■����■���■��������■■������■�■■ ■■■�■■■■�■■■■■■���■■■�■■■���■■�■ ■������■■��■�■■■��■�■■■■■�■■■�■■�■■■��■�■■�■■■■�■�■■����■�■■■■��■■