Loading...
5115 Hwy 601N Lot 6-A •,.sF'.vf+-f'ti•�,..Y.�f f�2@'f�y*.r��� "'". '-.i _+'"C' t ... a v,- � ,. t .. -r:-t• i ' t . �, C S 3. » �._ '`�. it, '.Au �TtiION NO: 0744 DAVIE COUNTY HEALTH DEPARTMENT `'--' Environmental Health Section PROPERTY INFORMATION Permittee6'-i P.O.Box 848 i' Name:_8; sl.j / Mocksville,NC 27028 Subdivision Name: f �� property:. j� Phone#:704-634-8760 . Directions to �� � Section: Lot: AUTHORIZATION FOR r WASTEWATER' Tax Office PIN:# �� SYSTEM CONSTRUCTION Road Name: (D Q I lY Zip: r �a **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 Fonn/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 FORA PERIOD OF FIVE YEARS. . ENVIRONMENTAL HEAL SPECIALIST DATE ISSUED '✓' ,tit{'i.* (' xrn+ �S`" ..,y y� 7` DAVIE COUNTY HEA DEPARTMENT r . f IMPROVEMENT AND OP.ERATION PERMITS PROPERTY INFORMATION P�rrmtte"e-'� Name. Q`:JLY /✓ Subdivision Name: Directions to property: Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:#�l Road Name: /r. Zip: 'rG **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. (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 Y ! ae, PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALT 4 SPECIALIST DATE ISSUED: SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS .J #BATHS &L #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZES TYPE WATER SUPPLY dd!ftd DESIGN WASTEWATER FLOW(GPD),_-2Z.. NEW srrE_L&_--*' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 6W4 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH "LINEAR Fr. !JO OTHER Q REQUIRED SITE MODIFICATIONS/CONDITIONS: /'�/�/.I ,0 D����f IV IMPROVEMENT PERMIT LAYOUT Yt LIC n )©t` F "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)6348760. OPERATION PERMIT SYSTE ALLED BY: b � 6 P� j AUTHORIZATION NO.I1J�—OPERATION PERMIT BY:. DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96(Revised) 4 • Kr • APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section SEP 2 7 1996 P.0.Box 848 Mocksville,NC 27028 ENVIRO"dN1ENTAL HEALTH (704)634-8760 DAVIE COUNTY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed RP-C Ce Contact Person // Mailing Address �� U,'ew crosr . Home Phone q 10- -y3 G b City/State/Zip Q A�.ror% , N. C, 17 Business Phone 910" 3 tc- Z nn 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 2"-Site Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: R"House 0 Mobile Home ❑ Business ❑ Industry 0 Other 5. If Residence: # People _� # Bedrooms 2_ # Bathrooms .2_ Ud"ishwasher ❑ Garbage Disposal O"Washing Machine * 0 Basement/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: 0 County/City WWell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ElYes 2 No If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE Property Dimensions: e- SUBMITTED WITH THIS APPLICATION. .5—z�-7�O'7cV WRITE DIRECTIONS(from JOffice Mocksville)TO PROPERTY- Tax ROPERTY:Tax Of ce PIN: #-t.' t J Property Address: Road Name City/Zip �0n.� �oa�► S-FA,�� Kd�• ►3aq 1 If in Subdivision provide information,as follows: 1 C1 1 Name: �} Section: Lot #: Ivor 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 1.e, to conduct all testing procedures as necessary to de ermine the site suitability. DATE 9, SIGNATURE ` Revised DCHD(06-96) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation Lynn M. Reece APPLICANT'S NAME DATE EVALUATED �d Q / PROPOSED FACILITY House PROPERTY SIZE (- 3,o aC SUBDIVISION Oak Grove ROAD NAME Highway 6018. Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit t-/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH _777-70 Texture groupL' Consistence 1/7 Structure /( 4b,- Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION l LONG-TERM ACCEPTANCE RATE ` ,3 ,,/� l SITE CLASSIFICATION: EVALUATION BY:Ky' ' LONG-TERM ACCEPTANCE RATE: - 3 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(OI-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■NNeNNNNNeNNN■stet■■■■■■■��:=-ANN■■■■NNNNeNNNNNNNtN■NNNNNNNNe■NNN■ ■■■N■■■■NN■■■N■■■■■■NEON■■■■Nei•■N■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■sssstsss■sss■■�■e■■■■■■■■■■■■stNNstNNstNNNNNNN■ ■e■■■■■NNNNENNE■NN■■tee■tee■■■■■■s■■ss�Ns■■N■■■■■■■■■■■■NNss■Ns■N■ ■■■■■■■■■■■E■■N■■■N■■■■■■■■■■■N■`rat■■■■■■■■■■■■■■►■■■■■■■■■■■■■■■■ MENNENMONSONMENNENnommomNEEMMEMENNEN MENNEN ■■■■■■E■■■E■■■■■N■■■■■N■■■■■■■■NN■■■Net■■■N■■■■■N■■■N■■■■■■��■■■NN ■■Ns■■Ns■■Ns■■Ns■■Ns■■Ns■■Ns■■s■■N■■s■t■■stssNNssNN■NNSNN■■NN■NNN■ ■■N■■NNN■N■■■ee■■e►t■essNN■tee■■■■■■se■■■■■■■■■NieNt�NN■st■■■e■■■■ ■■■tte■NN■■ttete■et■■■■■■►iN■N■■�■■■N■e..;ANN■■NNNr.�*�:�te■■■NN■■■■■N■ ■■■■■■■■■■■■■Ili/1LJY■�e■■t■\i��■■■t■t■►Iett■e■■■e■■■e■��ii■t■e■■■e■■■■ ■■■NN■■■■■■■■�■■■/:�,tt■■■■s�■■■■tet■'�eN■N■NNNtN■■ems%■■■■■■tete■■N■ ■■■■■e■■N■■■■■■■N■■N■■N■■■N■tete■■►�■■■t■et■■e■tt■■■■et■■■■■■e■■■■ ■■■■■■NE■■■■■■■■■N■■■■■■■■■■E■■■■■■■NNN■■■■■■eN■t■N■Nt■■■■■■■e■■■■ ■■■■■■■■■■■■■■■■O■■■■■■N■■■■■■■■�■NN■■■■■■■■eNN■■N■■■■■■eE■■■NEON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■O■■■■■■■■■■■■■■■O■■e■ APPLICATION FOR SITE EVALUATION/IMPROVEMENT . ERMIT&ATC Davie County Health Department 2 2 Environmental Health Section D L5 L5 P.O. Box 848 MAR J 01997 Mocksville,NC 27028 M (704) 634-8760 ' ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS THE REQUIRED INFORMATION IS PROVIDED. r 1. Name to be Billed /)�D��T 4115-a J Contact Person 905L2j /'I�5-�io Mailing Address • �3 �Ul Home Phone gio 77W/,YI 3 City/State/Zip C le m m a w l✓L Business Phone 1 g/0 7"- 7d I 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: [ ] House [Mobile Home [ ]Business [ ]Industry [ ] Other 5. If Residence: #People 3 #Bedrooms z #Bathrooms _ j'bishwasher[ ]Garbage Disposal [,14ashing Machine [ ]Basement/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: [ ] County/City []'Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [1.]'No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** %10F THE PROPERTY MUST BE y SUBMITTED WITH THIS APPLICATION. Property Dimensions: 1 �� C0� 'WRITE DIRECTIONS(from Iocksville)TO PROPERTY: Tax Office PIN: # .) /37v�f 5Ii.-y �.�/ n/, Go l///rn /� p $U hh ' /o-� loL�t r On/ fe. f�' �v✓�G�./i:f/ /K K/ PropertyAddress: R6ad ame / v2-t'y� , City/Zip Z-2 63/NyAy-// If in Subdivision provide information,as follows: Name: V/f'<6eo,K- — 'old e, �•� 1 2 °"' O� Section: Lot#: L A meq. � t o 44 ; 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 P'0 C5�' )) / S�f^/ to cjmduct all testiri2 v o edur s as necessary to determine the site suitability. DATE 3/I�/ `j7 SIGNATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAWINC7 YOUR SITE PLAN: I I ;SjGNEO HEREBY N.Q M INAt-%0 . F,. DATE -OWNERA0FR0Vk,'P,'jN y DOES R IIi UDE APPROYAl. DATE yS1GNED :UWNER. OF,RUILDINC5�Oft�StRvmu, , v �' •'ry'd z s`,J r SlGi+iED. .�•. .. .. '� r,r , OWNER 'trM i � ".r� r '.SIGNED ;' . : ..:� >. .� .,,•� '� 1f •MRI G.f 4... �s a OWNER DIRECTOR,,'00 » P TAX LOT 31.04 i FELIX L. CARBAJAL 172-351 ` FRED W. GENTLE a t ',82-16'* F N 26.45'13.' W ,' M 649: 9' 4.754 acres (A ---- . .__ STR 211:67' .. . EAM (,OC APPRQX. a t�f N 23'28'37' w , 18#36;4. b,' ' - 65.00, , Z Ln ,(a Go tr � a• �.. . • ' N 31'2342' W 259.52' 111285. sq.£. 1.000 acres 2.55 acres J► TAX LOT 30 & 30.01 cn ✓�, WW LYNN ,M. REECE Lq o� s 171-601 to N .. ...,__ 40' L a_• N o 175-840 40' Ar 209.47' -� ____w 123.25'. CER,TIFICATF nF APPR13VAL QF PRiVATF Lo rn <QN-SITE) SEWAGE``.DISP❑SAL SYSTEMS � lil,HEALTH. DEPART1FNr,fAS-CQtt FERBY' ffT; E DJVIE1rlJ rt:'r1 z .. ... .y.r 'n. iwwwM. .-,...w.•r'� '7AII'•rnJM►C'� 4M FJ , r