Loading...
349 Big Oak Ln DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �,� �".� s-� v�� � � P.O.Boz 848/210 Hospital Street • ' Mocksville,NC 27028 � (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001612 Tax PIN/EH#: 5850-99-7644.01 Billed To: Sean Sprinkle Subdivision Info: Reference Name: Location/Address: Big Oak Lane-27028 Proposed Facility: Residence Property Size: 2-3 acres ATC Number: 2772 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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(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 � #People Z #Bedrooms � #Baths� Dishwasher:� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �.�L Type Water Supply G�1P// Design Wastewater Flow(GPD) Site: New� Repair❑ System Specifications: Tank Size�t10 GAL. Pump Tank GAL. Trench Width�6 �� Rock Depth� Linear Ft.� Other:��� -.f''�7 �.�y� U� Required Site Modifications/Conditions: IN[PROVEMENT/OPERATiON PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF G `�BELOW FINISHED GRADE. ****NOTiCE: Contact a representative ofthe Davie CountyHealth Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.**** � � — ..� Environmental Health Specialist's Signature: � ,. � Date: �S h c DCHD OS/99(Revised) . , �� DAVIE COUNTY HEALTH DEPARTMENT . ' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990001612 Tax PIN/EH#: 5850-99-7644.01 Billed To: Sean Sprinkle Subdivision Info: - Reference Name: Location/Address: Big Oak Lane-27028 Proposed Facility: Residence Property Size: 2-3 acres ATC Number: 2772 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLTST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This 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 WASTEWAT � CO STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � - � Date: '�'S — �}l CERTIFICA,,TE F COMPLETION C� **NOTE** T'he issuance ofthis Ce 'ficate Co plet n sh 11 i icate the system described on ImprovemendOperation Permit has been installed in comp �ance 'th icle 1 o G. .Chapter 130A,Section .1900"Sewage Treatment and Disposal Systems,"but shal 'n NO A be t en s a uarantee that the system will function satisfactorily for any given period of time. �I� �b� � Septic System Installed By: �,L/�-FyL (���,<-%.�� Environmental Health Specialist's Signature: Date:�` 2?�2 �� DCHD OS/99(Revised) . o�. �j�- i � � i ' " ' APPLICATION FOR SITE EVALUATION/If�1PROVE1titCNT P�[tAti�. CL5 � �I � �'' ;' � Davie County Health Department �'�+ Please complete the highlighted area(s) d � Environmenta/Hea/th Section ' � �' e����� .o. s o x 8 4 8/2 1 0 H o s p i t a l S�r e e t , �1 A R F ?��� ; return. � � Mocksville, NC 27028 (336)751-8760 � �O ��� � �'�VIROI�MEPJTAL NEALTH ***IMYORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T � � UFR� INFOR2�ITION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nama to be Billed ��-� 5��� N 1'�LE Contact Peraon ��p�� s r R�N���_ Mailinq Addroea 3�y1 /�I�-j- �t'T Y� i�T��. flome Phono�_i—�3�� �"'� b - � 25q� _� City/State/ZZP tv{Q('�V( L� E �C � (Q�15 Hu ' Phono �3 �lQ ) -( � J`S 7 9 . 2. Name on Permit/ATC if Different than Above � � Mailing Addresa City/State/Zip / ���-S � ' '�� � 3. Application For: C'ISite Evaluation ❑ Improve t Pe t/ATC F3o 4. Syatem to se�„ica: � House 0 Mobile Home ❑ Bu ness Industry ❑ Othe 5. =f Residenco: � People �_ �k Be ooms � # Bathrooms �� f.�7 Dishwasher (7 Garbaqe Disposal Wsahing Machine C Basement/Plumbing ❑ Ssaement/No Plumbing 6. Zf Huaineea/Induatry/Other: Specify typa � Paoplo A Sinke � Commode� � Shoxera � Urinals �! Water Coolors IF FOODSERVICE: # Seats Estimated Water Usage (gallons por day) �. Type�of water supply: ❑ County/City Q Well ❑ Community e. Do you anticipate additions or capansions ot tt�e facility tl�is system is intended to servc? 0 Ycs L'f No lf ycs,what typc? ***IMPORTANT***CLIENTS MUSTC06tPLETETIi� RL'QUIKED PROP�RTY 1NrORMATION RGQUCSTGD BELOW. Either a PLAT or SITE PGAN h1UST BESUBMITTCD by tlie clicnt with TIIIS APPLICATION. Pro��crty Dimcnsions: �'�pf, 02 "' 3 Qe.fC WRIT�DIItCCI'IONS(from blocluvillc)to f'IiOPLIi'1'1': Tax Oftice P1N: # , S�-S 6— �� �����` ��g � � ��o� � mi�r�s PQSs �1e.. Property Address: Road Name �{G Ge41� l�-NE �Q!mi r10"I on �� '�JC[ � — ►`7�`p d" C;tyiZip {�(OC,KSv��F �p�8 C Qa k La�n t s Gn �e ����-� lf in a Subdivision providc information,as follows: n�('� .�l�S �h� 1'1of S2 harrZ , Namc: Section: Block: Lot: Date Property Fla�gecf: l� Tt�is is to certify t6at the information provided is correct to tl�e best of my knotivlcdge. I ttndcrstand tLat any permit(s) issucd hcreatter are suUject to suspension or revocation,if the site plans or intcndcd use cLange,or if the infurmalion submitted in this upplication is falsificd or changcd. I,also,uaderstand thal!am responsible jor a11 charges incurrc�!jrom this applicalion. I,I�ereby,give consent to the Authorized Representative of the Dnvie County I�calth Department to enter upon abovc described property located iu I)avie County pnd owned by to concluct alt testing procedures as necessary to deterinine the site sui bility. � DATE 63�6 S�O I SIGNATURG � TIiIS AREA MAY B�USED FOR DRAWING YOUR SITE PLAN(Include nll of the following: �aisting and proposed property lines and dimensions, structures, setbacks, and septic locations). . �r �� ' Sitc Rcvisit Cl�argc 3 � va���s�: 1 ��- ���� Client Notification Datc: �`� � �`�� � EHS: S.a.._ ,.�— (� .:., �� _ (�, ��-`�'"� Accouat No. `E� � Z_ V � � Revised DCHD(07/99) �' p�� � ' Invoice No. �� �t-`� � � � -L S' � �.••Z.. �` /!'Z ` L�-�-�"-�� . � . �1 �� _ J / fNr� � ! � 7 DAVIE COUNTY HEALTH DEPART'MENT , • • . Environmental Health Section � � � � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001612 Tax PIN/EH#: 5850-99-7644.01 Billed To: Sean Sprinkle Subdivision Info: Reference Name: Location/Address: Big Oak Lane-27028 Proposed Facility: Residence Property Size: 2-3 acres Date Evaluated: �-- /-s �� Water Supply: On-Site Well �- Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH `� �`` Texture rou Consistence r— 1' Structure /� Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE .2� SITE CLASSIFICATION: � EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: REMARKS: l��►���� ���J C 'p �` �' 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-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv 1:1,2:1,Mixed otes 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-gaUday/ft2 DCHD OS/99(Revised) ■�■���������■�■�■��■��■■�■����■■���■��■�■■�■�■■■■■��■■�■�■�■ /�■�� ■����■������■■■■�■���■����■�■■�■■��■���������■��■��■■��■��■�■��■■■ ■■�����■��■�■■�■���■■��■��■■���■��■■�■��■■■�■��■■��■��■����■�■�■ ■����■■�■����■�■��■��■�����■■■�■ ■�■■■■�■■■■���■��■■■■■��■■ ■�■�■ ■��■����■�■�■��■�■�■■��■��■��■�■���■���■■■■�■■��■0■���������■■���■ ■■���■����■����■i���■■���■�����■��■��■�■■��■■�■■��■��■�■■■�■����■■ ■��■■■■�■■�■�■�■■�■�■��■��■■���■��■■���■■��■■�■�ao■�■■�■����■��■■■ ■����■■■�����■■�■�■�����■���■■�■��■��■�■■�����■��■��■�����■���■■■■ ■����■■����e■■�����o�■��■�■■■��■����t������■■■■■�■��■�■����■���■�■ ■��■�������■�����������■��■�■��s�■■���■■��■�■��■■��■��■�■■���■■��■ ■������■e■�■�■��������■■��■�■�■■�■��■■■�■■■■■�■■�■��■■�■■■�■��■�■ ■���■�■■���■���■■■�����■������■■ ■���■■��■��■��■��■��■�■��■��■��■ ■����■���■�■■■��■��■■�■■�■■���■��■■���■������■�■■��■����■�����■�■■ ■■■��■��■��■■���s�e�■��■�■■��s■��■��■�■�a■■■����■�■��■�■�■��■■��■■ ■��■��■��■�■�■��■�■����■��■���■■�■����■������■����■�����■■■■■■■��■ ■■■�■�■��■�■�■��■�■■��■■■�■���■��■■�■�����■��■����■��■■■■����■■��■ ■����■�■�■�■����■�■����■��■���■��■■�■■■��■■�■��■�■■�■■�■■��■■�■�■■ ■t■������■���■■����■■��■��■�■�■��■■������■����e���■�■■■■���■■���■■ ■�■��■���■��������■■���■�■■�■■■����■■��■■�■■�■��■��■■■������■�■�■ ■�■��■���■����■����������������■ ■■■■��■■�■■■■��■��■��■��■�■��■■■ ■�■��■�t�■■�■�■■�■�■■��■��■��■■■�■��■■■�■■�■��■��■�■■��■��■��■��■■ ■����■���■■�■��■■��■���■��■�■�■�■■�■■■■�■��■■■���■�■■■■■�■���■��■■ ■�■■�■��■■■�■�■■■■■■�■����■�■�■�■■��■■�■■��■■■■��■�■■�■���■��■�■■■ ■�■��■■��■■������■�■■��■�■■�■■■��■�■■■■�■■■■�■■■����������■�■■�■■■ ■��■�■��■�■�■�■�■�■■�■�■�■■���■�■■�■■�■�■��■�■�■■��■■t■�■■��■��■■■ ■�■■���■■�■�■�■��■�■���■�■■���■��■�■■■��■��■■■■�■��■■���■■��■�■■�■ ■�■��■��■�■���■�■�■■�����■■�■■■���■�■����■■�■�■■��■����■■■■�■■��■ ■�■��■��t�■�■�■�■�■■���■�■��■�■■ ■■���■■��■�■�■■�■■��■■■■■■■■��■■ ■��■■���■■■����������■■�������■�■��■��t■■�■�■■�■■��■����■■■■■���■■ ■�■��■��■■■���■�■�■����■�■��■������■�■�■■�■�■■�■■■�■■���■■�����■�■ ■��■����■■■�■�■���■■��■■�■��■�����■■�■�■�■■�■■■■������■■■�■■�����■ ■��■�����■■�■�■���■■���■�■�■■■��■��■�■�■■�■���■■��■�����■���■����■ ■�■��■■■������■�■■■■���■����■�■�■■�■�■�■��■��■�■■�■■��■�■�■■■��■■■ ■�■��■�����������■�����e����■�■�■■�■■������■�■�����■■�■�■■��■■��■■ ■�■��■���■■�■�■■■�■■■■�■�■■�■■■���■�■��■�■■�■��■■■■����■�■�■����■ ■�■��■■���■�■�■�■�■■�■�■�■��■�■■ ■■���■■�■�����■�������■■■■■����■ ■�■��■■��■■������■■■���■�■������■■■■����■�■��■�■��■■��■�■■■■��■��■ ■���■■■■�■■�■�■���■■■�■■�■��■���■�■■�■�■■�■��■�■��■■����■■■■��■��■ ■�■�■■■■�■�■���a■■■���■■�■�■■��■■�■■�■����■��■�■���■��■■■■■■��■■�■ ■�■��■�■�■�■�■�■�■■����■���■���■■�■■�■�■■�■■�■�■■�■■��■■�■■■�����■ ■�■��■■����■■■�■������■■���■►•,��■■�■��■■■��■�o■�■��■���■�■■■■■��■�■ ■�■��������■■��■������■�■■�■�■�■■�■■����■�■��■�■��■■��■�■�■■■■■��■ �iiiiii�iiiiiii�iiiiiii�iiiiii�iiiiii�iiiiii�iiiiii�iiiiiii� ■�����■■■�■■■�■�■■���■■�■�■■���■�■■�■�■��■��■����■■�■■■■■■����■■�■ ■��■■��■��■■�����■�■�■■�■�■■�■■■�■■�■�■��■■��■■■��■�����■■�����■■■ ■�■■����■�����■�■■■■�■��■��■�■■■�■■�■��������■�■�■■��■�■■�■■■����s ■��■�■■�■�■���■�■�■■■■�■■�■■���■_�===��=����■��■�■■�■■�����■�����■�■ ■���■■■■��■�■�■�e�■■�����==::��■�������i■■■■��■�■��■■�■��■■■■■���■■ ■■��■�■�t�■���■�■������■��������■�■�����i■��■����■��■■��t���■■■■�■■■ ■■■������■����■�■�■■■�■■�■i�■�■■■�■�■��i■�■■�■■����■■��■�■■■■■����■ ■■■■■�■■�■■���■���■■■■�■�ai���■�■ ■�■■ri■�■�����■■�■�������■■��■�■■ ■■�■■�■■�■■�■�■���■��■�■�■i�■v�■��■��■��■�■��■■■■��■�■■�■������■��■ ■■�����■�■����■���v�a■��■�■�����■��■���■_■��■��■■�■��■����■■������■■■ ■■���■�t���■��sa���.■��■�■L==:::::i���■��■��■■■���■���■■■■■■■����■ ■����■�����■�����■■�■��■�■■�■■■��1���■�■■�■���■�■��■������■■■■■�■�■ ■�■■�����■���■����■�■��■�■����■�1!'�i�■�■��■�����■��■�����■■�■■■��■■ ■�■��■�����■���■�■i�■■���■�■■�■�Y■■��■■��■��■��■��■���■�!■■�■���■■ ■�■������■�������■��■�������■�����■��■�■■�����■�■■�■�������■��■■■ ■����■�■�■��■■�■�■■�■■■■�■��■■■■ ■�����■■�■■�■■��■�■■���■��■���■■ ■������\�������■�■�■����■����■����������■��■�����■■�■■■■����\��■■■ ■�����������������■■■■�����■������������■��■�����■�■■■�■�������■�■ ■��■■���■��■■■�■�■��■������■�■��■�■■�■������■����■��■■■■�����■■■�■ ■■�■■������������■�■�■■�■�■■■■��■��■����■��■��■��■■��■�■■■■■■����■ ■���������■�■�■■�■�■����■�■■■■�■■��■�■��■��■■�■�����■■�■■■■■■■■�■■ ■■��■�����������■��■�■��■��■�■�■��■■■■�■�����■■�■■�■■■■■■���■■■��■ ■■����■�������■�■��■�■�■■��■�■�■�■����■�■■����■■��■■��■����■■�■�■ ■■��■■■■■■■�■■■■�����������■�■�■ ■��■�����■■■�����■■■■■■�■��■■■�■ ■�■�■�■���������■��■�■■■■�■�������■■�■■■��■��■��■�����■■■■■��■■��■ ■■��■■■■��■S■�■■���■�■��■�■■�■■■■■■���■■!■■�■���■���■■■■■■■������■ ■■��■����■�■■■■�■■�■�■■�■■����■��■■��■■■■���■■■�■��■�������■■■■�■■ ■■��■�������■���■��■■��■��■���■��■■���■■■■■■�■■�■■■■������■�■■■■■■ ■���■■■�■■■■■■■�■�������������■■�■�������■�■■���■■■■��■�����■■■�■■ ■■�■�■������■�■�■�■■�■■■■■■■■����■■�■■■��■■��■��■�■■�■■�■■�■■■■�■■ ■���■■�■■■■�����■�■�■■■■■■■■■�■����■■���■■����■�■■■■�■�■��■■■■�■■ ■■■■■■��■�■�����■�■�■��■�■��■�■■ ■���■■■■■���■■��■����■�■�■■�■�■■ �t���������■�����■��■����■��■������■�����■■�■��■�����■■■■���■����■ ■■■■■■��■����■�■����■�■��■■■■��■■■■■■���■■��■�����■��■�■�■■■■����■ ■���■����■�■�■■■������■��■■�■��■■��■����■■■■����■■�■■■■■���■��■■■■ ■■■■■■���������■■■����■■���■�■��■�■■���■■■■��■■��■�■■■����■■■�■�■■ ■�����■��■■■�■■■��■������■�■■■�■��■■�■�■■���■�■����■■���■�■����■■■ ■���������������■■�■■■�■■�■���■■■■�■�■�■�������■�■■��������■■�■�■■ ■���������■■■■�■�■��������■■�■�■�■■�������������■��■���������■�■■ ■�■�■■�������■■■■■�■���■■��■■■■■ ■��■�■�■���■■��■■�■■����■����■■■ ■�■■����■■�����■■�����■■�����■■���■■�■�■�����■���■��■�■■■��■■�■■�■ . , , � r . � y D�k�l� ��U��I�LT�i g��'��T1V��1`T - _ . _ _ _ _ ..,._ . ._...._ . . . . ._..._. ..; ENVIRONMENTAL HEALTH SECTION P. O. Box 848/210 Hospital Street Courier #09-4�06 Mocksville, NC 27028 Phone #: (336)751-87G0 March 15, 2001 Sean Sprinkle 349 Big Oak Lane Mocksville,N.C. 27028 Re: Site Evaluation/Big Oak Lane Tax Office PIN: #5850-99-7644.01 Dear Client(s): As requested, a representative from this office visited the aforementioned site on March 15, 2001. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site,the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, ,��'�t��.��• Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/di Enclosure(s)