The URL can be used to link to this page

1900 Cana Rd (3) DAVIE COUNTY HEALTH DEPARTMENT Pd, ' Environmental Health Section P.O.Boa 848/210 Hospital Street O Mocksville,NC 27028 I (336)751-8760 l Account #: '990004148 Tax PIN/EH#: 5832-42-9238 Billed To: Sal D'Amato Subdivision Info: Reference Name: �__ / Location/Address: 1900 Cana Road-27028 Proposed Facility• Barn hf4k 206 r►'i Property Size: 34 acres ATC Number: 4542 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 CON - U ON I VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature. Date: i 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 11 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 of time. •C00J -- 1,31 31' G�0"y Sr' c+b"AZ \ -70 erg Septic System Installed By: J� '"i Environmental Health Specialist's Signature. Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT f r Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990004148 Tax PIN/EH #: 5832-42-9238 Billed To: Sal D'Amato Subdivision Info: Reference Name: Location/Address: 1900 Cana Road-27028 Proposed Facility: Barn Property Size: 34 acres ATC Number: 4542 **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 #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type " #People q #People/Shift #Seats Industrial Waste: ❑ Lot Size 5`J 44°S Type Water Supply WL9-L– Design Wastewater Flow(GPD) 100 Site: New 0"'Repair❑ �� f System Specifications: Tank Size '�GAL. Pump Tank GAL. Trench Width -Rock Depth N Linear Ft. Other: ��s /` ;� t11�/aJ DIST -- , lot-�r� io,� fox Required Site Modifications/Conditions: //JSY CF Ahol— IMPROVTIPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW ^ ED 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 in.on the day of installation. Telephone#is(336)751-8760.**** TO Exp :a L9 i tLk�l 4d �° r. A,-J Pi -DR I VF,. MAX +-1 261' 46,EtWonmental Health Specialist's Signature: Date: DCHD 05/99(Revised) 10/19/2006 14:00 FAX12002/004 'rS� ^4 f3 t]6 1 O,e�A]i'm ' day i e couris� nr,vhea 1 t:hi 33�i .75 1 8796 p• 2 :t' 1 AYPLIC TI OR ''*ITE EV,ALVATIONAMF-RO'VEMENT PERMIT & ATC 4 20 ]Davie County Health Department X f Environmental Flealth +Sectl%ori A X12 P.O. Dox 848/210)EHospitni.Street 1✓Z � 1NVtROhMEMALHfAL 1 lKocksville,NC 27018 DpAECOU0 (3367751.-8760/Fax (336)7:11-8786 Application For:>aite F-valuatiun/Inip,•,vcmexxt Permit ❑ Authorization T'o COnsmtet(ATC) Oth i wW•/MPoRT�lN]^�•►7FL1S APPLICA1 XON CANNOT BB PROCESSED V11-•L1=SS ALL OF THr:lr rsQuIrzr_t) I11W0rLMAT10N 1S PX0VID$A. Recur to the n*4rORMATION BULLEI-1 nr for instructionx. APPLICANT INFORMATION Ar 3 Name to be gilled Comaet Person GY. Lulling Address0, F1Ai71C Phone :13 . ZZ #. City/State/zT_P . 0 8/.��j� _BUSi!'c<SS Phone�n.5 &'3Z - o-t TL4 l , ' Name on Perrnit/AT'C ifDif�'er•e zi tliun Above _ � Mailinp Address City/5tat.ei/Zit, - -- PROFS TY 1NF0FLMA't•10N _ i. NOTE: A survcy'ptut or site plan must accompany this application. (Permit is valid for do months w•Ili site plata,no expiration wi eo p;�.tc 1 t.) ',. Street Address I�f70 ea.Y1LIZeQ City 1►IOL 5 �� TaX PIN#: 77 _ Subdivision Name Section/Lot# _Lot Size T�irCCtionsT Site: 70,Y70 _ VWJf �xQ� j i2 O 4lJ�COx i DateHouse/Facility Corners.rlaggcd � ec CLr�, we- If ' If the answer to any Of the following quest ions in yes su porting docnmrntt'tion rfnust be aftnc'% Are there any existing wastawate.,systems on the site? >Wes ❑No gich D008 %sel -ea- �� oes thenite centaiajurisalietior.al Wotlands? ❑Yes DAVo A;orLGse,tjcr- Are there any easements or right-of-ways on tho site? ❑Yas)GNo Ho{-Q-&kVL— Is rho site subject to approval by '.nothcr public agency'/ OYes Delo / Will wastewator othei:than domestic sewage be generated? ❑Yes C&lo IF RESID NCE FILL OUT THE FIOX BELOW People #73edroor.is #f bathrooms F ` _ Garden Tub/Whirlpool ❑YesjNo "! I Basement: 13Yes_ER!Jo I3asonwrit Plumbing: ❑Yes "o JF NON-FLESIDENCi3 F11J.,OUT THE BOX BELOW Type of i'aciliry/Bosiness (/1_ TO Square Footaga ofBuilding�_ # Peopl t7 / >�Sinks_� #ComrJ rnors_� #Showers I 3 Urinals Bstimatcd Water Usage(gallons per d:iy)_LD (Attach docun-wntation of eitnilur lacility water consumption) FOODSERVICE ONLY: #Seats Type system requested; Conventional f lAccepted olnnovative OAltemativc CiOther. = ;• .ter 5;;Pi lY ryP4; ;- CoLl'ay/City Water 47 New Well xisrin c;Well U Community Well . Do you anticipate additions or ezparsi*ne, !f the inciliry this system is intended to serve? Yes i 7 No If yes,what type' �. This is to certify that the inftirrnation provi led on this application is nue and correct to the best of my knowledge. I understand that l' any permir(s)or ATC(s)issued hereafter ain subject to suspension or revocation if the site is altered,the intended use changes,or if Elie information submitted it)this applic.cio n is fhlsired or changed. /understowl Phar I ant!-caponsible for all charges incurred from this application. 1 hereby grant right :xf entry to the Authorized Representative of the Davie County 13ealth Department to conduct necessary inspections to t rmi a eompli�??cc with applicable laws and rules on tine above described property located in Davie, d owned by X1111 IM ICA _ _ _ Site I2cvisit Charge Property owner's or owner's regal representative signature Datc(s): �D �T `� I f .! I Client Notification bate; Y V��"� .�� U14 S- _ Sign given ❑Yes ONo Revised 2/06 � � ronjt tY r t N �. ._ ��sslUlm Il-1-06 "•.- � a" Y+l+ �� ,-'Fyanra �F' .�. ONR � A �V �T1 � Ma�„h �• � �. � -All Olkl Gam.- ' $. yppA d yn Iv ve E� ��„ 4 k ti x '�+d, xn #�• 4 ' r, aZ,XC s `F hh i 1a x x. �n�'r 4 1�rl% • '� • �� d {Z N..0. .n . aFcu...., VIC \ AREAy Y6>v4 WRES ISI x^ r. f�T ow Val avvti F l r 1 I i I \ \ \ \ E Msc Msc + El -- MsD 9239 790 W, l m 189C LUTZ LN 69 _ -- N _ v b "+Y „ 4' SII r �r 6ZLfi (va W li ay ,,.�%{JE<L��i�1:,sYlY?51�iiAf.Y. ._•. � +' Y� VlS1 0L P � a t i N r i i - i I nt_ 77� fso 40 1 • r 1 � DAVIE COUNTY HEALTH DEPARTMENT ' r r Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004148 Tax PIN/EH#: 5832-42-9238 Billed'To:, Sal D'Amato Subdivision Info: Reference Name: . Location/Address: 1900 Cana Road-27P28/ Proposed Facility:.--.,Barn Property Size: 34 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 sitionI Slope% O HORIZON I DEPTH 19-s2- 0-'90 O Texture group i- ' Consistence S5 Structure Sok Mineralogy S._ HORIZON II DEPTH 2' p+ Texture group C, 5-1c. Consistence ; s v Structure Mineralogy1wl kF► C;,XP (5ap HORIZON III DEPTH Texture group Consistence �. Structure Mineralogy M the"-) HORIZON IV DEPTH Texture groupSC11 S Consistence Structure1S - Mineralogy5. SOIL WETNESS' - RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P5 * ' LONG-TERM ACCEPTANCE RATE e DUr"TU CXF G SITE CLASSIFICATION: EVALUATION BY: ' LONG-TERM ACCEPTANCE RATE: �� OTHER(S)PRESENT: REMARKS: 1_1 LEGEND Landgenpe 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 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 rloS� 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 05105(Revised ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■r�■ell■■■■■■■■►r!�■■n■■■■■■st■■■■ MENNEN iiiiiiisiiiiiiiiiEmmons�'�iiiimmiMMM"pM iio iiil it°�■iiviii i��iii�i ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■i■■■■■■■s■■■e■i■■■■■■■i■��'►r■■ir■e■■■ase■■■■ ■■■■■■■■■■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■■i ■■ell■■■■■■■■■i■■■■i■■r:�■■■s■■i■uie■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■a■■■■■■i■■■■■II■■■■■■s■■i■■■■■■■■■■■■■■■nye■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■u■■■■■■■■■■■■■■■■■■■■n■■■Ilan■■■■■■■■■■ t , Davie County Health Department Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751=8786 Improvement Permit Sal D'Amato 1900 Cana Road Mocksville,NC 27028 Re: 55 Acre Tract/Cana Road Tax PIN: 5832429238 Dear Client(s): This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve: Wastewater Design Flow(GPD): l Valid: ZYears ❑No Expiration System Type: ❑Conventional ;?5(ccepted ❑Innnoovatiivee^ ❑Alternative ❑Other Site Modifications/Permit Conditions: Site Plan 1 6A)I LL PZ---Q04 /1-IITI L AM •Co:� n al al is Date '. .letter 7/06