The URL can be used to link to this page

215 Boone Ln (3) DAVIE COUNTY HEALTH DEPARTMENTS ' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000670 Tax PIN/EH#: 5756-17-5164 Billed To: Tammy Frost Subdivision Info: Reference Name: Location/Address: 215 Boone Lane-27028 Proposed Facility: Residence Property Size: 11 acres **N&11I 1 iP iproMint/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<— #Bedrooms— #Baths Dishwasher:, Garbage Disposal: ❑ Washing Machin 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) 1� Site: New Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width(Ti Rock Depth! o Linear 1700 Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 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)751-8760.**** r Environmental Health Specialist's Signature: / Date: DCHD 05/99(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000670 Tax PIN/EH#: 5756-17-5164 Billed To: Tammy Frost Subdivision Info: Reference Name: Location/Address: 215 Boone Lane-27028 ATC Number: 3181 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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 1�-ef ter 130A,Section:1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY a ante at the system will function satisfactorily for any given period of time. C� r Septic System Installed By: -Y � J Environmental Health Specialist's Signature: G�/(.f Date: DCHD 05/99(Revised) rim APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Lti U E/IVftflme/ItaiHealth Section P.O. Box 848/210 Hospital Street JUN I Mocksville, NC 27028 8 8 2002 (336)751-8760 ENYIRONM ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS INFORMATION IS PROVIDED. Refer to theINFORMATIONINFORMATION BULLETIN for instructions 1. Name to be Billed Z7M ry--%%� ( Feo S T Contact Person LIQ?--(001 �j1 ' ( .� a Mailing Address 1 ri 1 (\� rp`�'� /1 r� Home Phone 1 ��—`001 1 City/State/ZIP-00 0 c�(&� It � ' 1� �-7 V-Z-,Y Business Phone . ] Leo 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 Service: X House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms �" # Bathrooms Dishwasher ❑ Garbage Disposal 'Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well 13 Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes XNo If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUS7'BESMMI7TED by the client with THIS APPLICATION. t Property Dimensions: k Gl!`',. I ' W TRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # S r1rJ �p � q 5 u 4 (001 SnuA,16 ::b -b.,0-0-6-non Property Address: Road Name a �J E)Qons-Lh �_-`�1�Y n��-J, V1 SCJ `�61`tf✓I(Se�-�6>7 City/zip MDC kGj, R-C Q-1 Da`6 -[Lkr n (Z 0 4D LS 11 $t)one If in a Subdivision provide information,as follows: a o nos.4 b r i d -�t r L-- d1TU Name: li-)Dry- Lrl• (&y+ rt)q - 2n 4 e-n� (-W SR- has Wa�n.e Rome -Figr� . house t'5 mc, Section: Block: Lot: Date Property Flagged: _ —4 Ir - WI plc�S This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) JJ issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I,also,understand that I am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE�0�1 (� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): , Client Notification Date: e";7-e";7-Z '�p`l-- EHS• Account No. Invoice No. Revised DCHD(07/99) .r h AMA H`,`w�' �'`' tl7 - rr�$ �" / a✓a� 177 77 33 11131 Yi ,' ''' 3 '� H' d W r ✓h 9� �'✓fogm 'i"iN'I,Ij� �'1j331 3 1 31313 1 3 ID r �s ruglyg a- z a r `a x Via' #" Qu r c'h1,3 , 1 - ; 2 TALLell rai / MjQ3 1 Vg 551A ; , ; any,", r TM 3 3 >a?g 3g'3ya `r 'My AV ,. r r.rs' A s flu Ys a.lg� fix, P x 3 r x � s3 .:: „. ✓ a 3 4 L t a- �...m.. 3 3 x ' 3 `; "r v �3tV 3�313333sy '1 P1311k a VN- IRS3 333 3 ll 3 3 3 l3 tt s �� a �'a ✓tea: ,.a� ��,�h a� �>� b 13 3�3� �� " -�� ` CdA sura ,3 01 / ', t Holm 11 a cP Ks 13, TT Th /l ,zyy/ "it 33y3n�1 r r a a v ,r✓ j//, moi" ,� r 3 a3�33l :'333 l .c / s 3� tr 3 1 e 3� " .2 // /g/ / /i 9 r ✓ r'•Y t�.�k O k { �� 1,✓ sent O G Win:ITT A Div gjL 277 NN r / rb� 1Q Gs',4 s �✓✓f x A ,ykc/ s yr„+ N % o rot ,. '% ,1'r r,i�y✓��r ,�� d'/�fG, ,� /'r � /Hf£��r,/,r,� kfi i, /�9'H brr�'a'iM',3,f f y j 1��f 'YM i1✓3�..'A� $ ;^9, H.49x�f` { 3N f .za,.,y v a r� x, Y /%/ a jy/veyr✓ r%�"y /r�a �r`�* ' P :r +:'w�i+ f � �x m G x /d ,:, /f xv i' l;-r a..--��rY ✓ t R pr �r s ,� ' : y8 f baAn �r 3�k' a 3lAai' A.:�-,`4H tx f i €`a^ a .�d r "4� A q 5 ^3 r �, ,s, l 3 k 3 n � - as X33 i ✓s o '3nflfi'1'P��f N�� eJ�v -" a IF 7 � "'�" na6' k ij ' � s 43933'b.ti.1y �' ar�� z;aJ y �f / � ✓ �� c, � �, n�na r-A z=,, ,enc, z" x a r b A / ✓z T y3�'�3s�'�� rHu 'H�/., %✓y✓r%' y/ r s ,� y s �'' �,e 7v7>i' its up A / /�" .,:;$ �/f a.,✓ /5 - .za k 3 a�'' 653 3 �: ,4_"� �� 9 v vsj.rte $ sra ym". / i`r' 2c / .? - -.�,r r sl., .-�R ✓=, yy ,yt w A ✓9 tU 1 r a rs � H � � q ycyc. any Via , g, £zxrza` s13 �V31 13 �p r � _ � a '� „;m✓� r�i�� c„ ,r9y�^%r yam;, £ t4 a �' y�'D x/y � > 3r•� F F, 4 ,:::fir✓ ,Y'', „/r i Y / ra,rte,' ,,yy;; .t, -S c A a'^. t`Czwi %;r j rb'y r ap. Wow”, Lq ,. r� /, r✓ 3' ,i�: Xa�• � 5 �- s %rr /y„v ..:;.H ' fr//.., e✓✓ %� �' / .�✓% ,y.,v"r �r. y sni, ri,:<sa$zs,;- y`r� f, A ✓ / /r r ,:. '0r a3,, - r/� ISM , ,ria :, � r ��' gr�v 'r//s��"y �A, r rs 2 .s �_`� r?✓,✓F,�' ;a,'�' /r� vy «�� c ;'.��'�� r f A .U ':f 6 , r�/�,...///% /� z vd'n'/a ��/j.^' :.,r8i”' s,- ,,,�'., ai s m` ;;yi ^s�'r/ ,sr. .i/ "o iw_�. 's/�i �'�' ✓%/ ,✓ f'$r/r"�r///��%�/ �.��n/ /r✓fy. ':v '� r� � /'s,/'' � � K,,Ai„ cY �-f f--/ �� r///;l/ /� ',y.✓/ n /sC/✓ir - c,,: ;i r�`'` ,. r s t S' [�� a .-✓lam v/Hr 3Y r 9,. ......... ,��.�� ,v��✓�/r v, n�� v . 3/.y'`a � r% ,r.a.r a sy//s 7 r.riw�'�wl ,n �F'a 'r. �,, x, v a ,z n v yr � /�r///3p /tri /" /,, // �$x / nrr',//r' n%/ "�/ �,H ,qG�'y'�`'s�x x �%✓6r///�iy �ss '1 5 'sa � ".Y � "T �°� J✓ ra.,//„�r�� ,'Pa';, ..u'y r.i +n%/�; �,:” ✓ x z N. a �CVJ* i/ .ry„� r ii� r.c .,✓/ni,///�9i� ,�, s'r/✓�r �, y-� o a��rr l!'v�� fr Vii, r /r////„�'�'r as /,,/„ �a,�`„, l�� y/ yii r/y y//� 9ip��'ay'�$a�';, �M""':yM..:`�r�/ ✓r/y „, "qa ,,a r r s � r v$�3< r tr -y�j� /,".+a' //i;y; r,g;✓ ��',v �n /�f/'s�... s ,rid/sj vis Sy Jct yn. �, ,n a �y�i✓ rr' ar, � .z,� a...; y y q✓%` � Av r/;. r�'/% 9ywa ri /ri rs rn/ K,,. r ,� � °y' s /a �' ry, i,,� r�/,% n$ ri ,a.a;%/r✓a � /�',�%y r .a/r/ra`rfr/ °✓ �S kyr/y�icyyi �s� s/ 1 t=. $ x h DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION I PROPERTY INFORMATION Account #: 990000670 Tax PIN/EH#: 5756-17-5164 Billed To: Tammy Frost Subdivision Info: Reference Name: Location/Address: 215 Boone Lane-27028 Proposed Facility: Residence Property Size: 11 acres Date Evaluated: �✓/ � 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 group Consistence Structure Mineralogy / r / 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: /l� 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 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 05/99(Revised) ■■■■■ec■■■■e■■■■■e■■c■■■■■■■■■s■■■■■e■e■■ee■■ee■■e■■■■■e■ee■■eec■■ ■e■e■eee■■■■■■■■■■■■e■■■■■e■■■■■�■■■■■■■■e■■e■■■■e■■■■ec■■■■■eee■ ■e■■eeeeccee■eee■■■■■■e■■■e■■■■e■■■■■■■■e■■■■■e■■e■e■■■■■■ee■■■■■■ ■ceeeec■■eee■■■■■■■■■■cc■■■■■■■e■■■■■■c■■c■e■■■ec■ce■■■e■■e■■■c■e■ ■■■■■■e■■■■■c■■■■■e■■■■■■■c■■■■■■■cccec■■c■■■e■■e■■■■e■■■e■e■■eee■ ■■■cee■ecce■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■c■■e■■■■■■ceeceeee■cee■ ■■ee■■eee■e■■■■ece■■cc■e■■■■■■e■ ■■■■■e■■ec■■■■■■o■e■■■cee■■■■■■■ ■ee■■e■ec■■eeee■■■■ec■■■eeee■eee■■ecce■■■e■e■■e■■e■eceeeeeee■■e■■■ ■e■e■ee■ce■ec■■e■eeeeee■■■■■■■■■■■■■■■■e■■e■ceee■■■■■■■■■■eee■■■■■ ■ec■■eee■ecce■■■■■■■■■■■■■c■■■■■■■■■■■e■ee■■■■eec■■■ceeecee■c■■■c■ ■eee■eee■eee■eee■■ee■eec■■■■■■e■■■■■■c■■■c■ecc■■■■■e■■■■■■■cee■ee■ ■e■e■eeece■■■e■eee■■c■■■■■■■■■■■■■■■■■c■■e■■■■■■c■■ee■■■■■e■■■ce■■ ■■e■■eee■■eec■■■■e■■■■■e■■eee■■■■■■■e■■e■e■ece■e■■■■■■■cc■e■ce■■■■ ■e■e■eee■eee■eee■e■eeeee■eee■■e■�e■■eeec■■e■en�■ce■■c■■■■e■c■■■■■ ■■■ecce■ce■■c■■eee■■■■■ec■■■■■■■e■■■■■ee■ee■■e��■�■■eee■■■eee■■■■ ■ee■■e■ec■ceee■e■eee■■e■■■■■■e■■■■■■ec■■e■ee■■■e■■■c■■■■■■c■■■■■■■ ■c■e■ecce■■c■■■■■e■■■■■e■■c■■e■■�i■■■c■■■ees■■ce■■■■■■■■■■■■■■■■■■ ■c■e■■■■■cee■e■c■ee■■c■eeeeee■■■■■■■■■■■■cc■■eee■■■■■■■e■■■■c■■■e■ ■■■■■ecc■■a■■■■■es■■■eee■■■eeec■■c■■s■e■c■■■■c■e■ec■■■■■■e■e■■e■c■ ■■■■■■■■■■■■■■e■■■■■■■c■■■c■■■eee■■■■e■■■e■cc■■■c■■■■■■c■■e■■ee■■■ MEMNONiiiiiiiiiiii iiiiiiiiiiiiiiiiiiiiiiiiii�ii�iiiiiii::::��■■■■■■■■■■■■■■■■■■■■■■■ ■■■cc■■c■■■c■■cceee■■ecce■�occ■■e■■c■■■■e■■e�t■ee■■e■■c■■c■■■e■e■e■■ ■■c■ec■■■■c■■eee■■■s■■■■■iso:::■■■■■■■■■■■■■�■■■■■■■■■c■■■■■■■■■ec■ ■ec■e■eee■■■eee■■■■ec■■■■■■■■■■■e■■■�e■■■■■■■■c■■■■■■■c■■■■■■e■■c■ ■c■c■c■e■c■■■■ee■■■c■c■■■eee■■■c�■e■c■■ccc■ccc■■■c■■ce■■c■■c■s■c■ ■■■■■■■■■e■e■■c■■■■■er.�c■eee■■■■c■■■■e■■■■■■■■■■■■■■■■■c■■■ce■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ec■c■■■■■■ec■■■■■■e■■■■c■■■■■■■eee■■■■■c■■■c■■■ce■■eeeeceee■■ ■e■■c■■■■■eece■■eee■c■ec■eee■■c■eec■■■c■■■cee■■■■■■■■■■■■■■■■■■■■■ ■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■ ■ec■cce■cee■■■■ec■■■ce■■eee■■■■eee■■ec■■■■c■■■■■■■■■■■■■■■■■■e■■■■ ■■■■■■e■see■■■■■■■■■■■■■■e■■■■■■■c■■a■■■e■■c■■e■c■■ce■■c■■■■■■■■■■ ■■■■c■e■e■c■c■c■c■■■■■e■c■■■ce■■eee■■■ce■■c■■■e■■c■■c■■■■■■■c■■■■■ ■■■■■■c■■■■■■■cc■c■■■c■■e■■c■■■c■■■c■■■■■■■ecce■c■■■■■■■c■■■■■c■■■