Loading...
198 Ponderosa RdDAVIE COUNTY HEALTH DEPARTMENT t• Environmental Health Section P. O. Boz 848/210 Hospital Street / Mocksville, NC 27028 (336)751-8760 I IMPROVEMENT/OPERATION PERMIT Account #: 990002389 Tax PIN/EH #: 5823-54-6481.MW iII�B ed T MarhlNhi_ — Subdivision Info: Reference Nam iane Bax Location/Address: Ponderosa Drive -27028 Proposed Facility: Residence Property Size: 4 1/2 acres ATC Number: 3359 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 2 Dishwasher: X Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ 'I/1 Lot Size 7 x1 Type Water Supply A4'// Design Wastewater Flow (GPD) aC V4) Site: New Repair ❑ � System Specifications: Tank Size %ODd�GAL. Pump Tank GAL. Trench Width c�6 "Rock Depth �Linear Ft.� 11 Other: / iv &L, " pL - V9 Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a resentative 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�nrtQ T 0 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) Account #: 990002389 Billed To: Mark White Reference Name: Diane Baxter Proposed Facility: Residence ATC Number: 3359 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5823-54-6481.MW Subdivision Info: Location/Address: Ponderosa Drive -27028 Property Size: 4 1/2 acres 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: '6 Z Date: 1/ —171� `0—? 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. Septic System Installed By: Environmental Health Specialist's Signature:. Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROMIENT PERMIT & Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE INFORMATION IS PROVIDED. Refer to the INF( 1. Name to be Billed Mailing Address City/State/ZIP %/t'q C 14- /- E ,v C- 7-702 �n�;yME7Vr.,. 2 l UNLESS ALL THE RE t3-4/ ETIN for instruction . Home Phone ness Phone 2. Name on Permit/ATC if Different than Above •LL/j/1e ("La to Mailing Address C';/State/Zip 3. Application For: tli Site Evaluation ❑ Impro/vement Permit/ATC ll Both 4. System to Service: f_l House "obile Home ❑ Business ❑ I s TfJ ,ti iJ S. If Residence: It People p Bedrooms " ►1 Bathrooms Dishwasher II Garbage Disposal 1h4ashing Machine Il Basement/Plumbing fl Basement/No Plumbing G. If Business/Industry/Other: Specify type # People R Sinks 0 Commodes It Showers It Urinals It water Coolers IF FOODSERVICE: it Seats Estimated Water Usage (gallons per day) 7. Typo of water supply: fl County/City Xqell II Community 0. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes X No If ycs, what type? '"'IAIPOR7ANT*** CLIENTS X1USTC0Af11LETETHE REQUIRED PROPERTY IN1,011MATION REQUF.STE'D ItE,LOW. Either a PLAT or SITE, PLAN AfU,ST BESUBAIITTED by the client witli THIS APPLICATION. _ff / Properly Dimensions: '� WRITE DIRECTIONS (from Mocksville) to PRO11,1 1'1': Tax olree PtN: tl Properly Address: Road Name City/zip If in a Subdivision provide information, as follows: Name: Section: Block: 'Lot: r ( Dale Properly Flagged: TI(is is to certify that the information provided is correct to the best of my knowledge. I understand that any per111it(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 ant responsible for all charges incurred frunn this application. I, hereby, give consent to the Authorized Representative of the Davie County Ilealth Department to enter upon above described properly located in Davie County and owned by , �a �_,-ems->f to conduct ill testing procedures as necessary to determine Me site suitability. DATE, /7rJ d;1�1 — Sl�,NJTL\ZE 1II1S AREA MAY 13E USED FOR DRAWING YOURN property lines and dimensions, structures, setbacks, and 1 �0 AN (Include all of the following: Existing and proposed I�kitions). Revised DCFID (07/ 5 Nell 3 V�./ Site Revisit Charge Dale(,): Client Notification Date: EMS: Account No. Invoice No. a ✓ F � �,,. , ,-, n` � \ ir �•.,� � . . � _ ,,,,,, ti06£ t; vzae ti <- U £Ole£Ei8 p,Ctl � , ' �� � 5L1 , taeo'>�:e�u tvzot�'0�'t 9£l9 LLt4 �`^^Sr-�"""".--"".--�-•� �•rs?r . - .. �HYO'S . y'�..:4� � � � . . I .....i, �.,.L,�, . .... . . �l ..... ..... ...., 6E L� (FEO. . tveo��tara'z�� , ; ' i�r�rs � , ; , � " r �. , � s �3 � � � " ��� � � E r� y e ! ,atis # � ' � ��ou� a � � ;; � vvs� �' e�s e �� i t � � � t , ' ' � a � � . �..: �� �..'�. <-,�_„� � �`,����.,� _.:_e.a � i � „ n:,�,:,., r i � � ,,. �- � � ... � ..', ... . ' � � � .�9 . 9 __:69 , ���'t " � ^-H9,. .09.. _b4 __i-..�_ ...2�'Tt2 . � M z4� , �, ,: ��� ; � � ���s � � ���' �' �.8;:. f- '���� , ,, g�::: :� �; �r �.,,: ' I } /�/ry L849 � ` � 3 6 � � ������A�y/ � II � '� HL61�8£ � l,a� � / '"""'""" `•' i � -�a � i'--• .. ����/,vii// � ', � � � n ,,, �iijy�i - ,_ � i ' �� /,,. „ ,m�,�///'iio,�l �„��, 1,., . ��.., ,,,.„ �. �. ,,, ,,. ,.. ;. ' ���. ZIL . _ . .. . ��b� �� bCS (}P �� Cb4 �: II 1 �9L� 6 � 5£L£ �� �� 8LZ L4LL (v�Zo't) � ' E£8l �' , � HE4ot � � d000 s � � _�,r� � � �� res �', ���,. trsr� �, ' , � .� � ' , � ,,,,u,�r,--i�, � . , �. � � o�c �4 � � 9L4£ . .. .. . .. i . . f r {] ( g1�V � %, _ ,,,,,,,(t���'c'$ ' ' � �" ' YL£Z � ' L�£8 4£hZ tvti'�) ' � 5tvG :. � � z�? t� ��V , . CVZO'OZ3 "�-- ' � � � � � � � ^� \ � y ' 6SS5 8��E ' �vfls ct � (YrB£Fj '' �C�T�. �� � � ' �o� �� � ro � � , r � i394� ,-.—...»«..�.�.»:.«.... ----SI7w'1�3��_.�NL..,�/� � �.�. �Q 9� �� �� �� � S �� 7 Zj� � � �/6, t y � � 8 � ,E � ' .&�� � � � � � i .. T 4 � � CNZE L? k � 9L$Z ' � � , r o � � � a l3 . _ 4 � I �•�� 1� t S�4 y,� � t�66E � '- �.. � ,i i ��8' � „ _ _ � r , ���' x � � � � '� u zia an, � fvz�'B} i ,_ __�� ..� ��y 9t&9 � �F � �� i ���— y . �'H7-I 4 P� 4 .. � �..... � (i�JW �4�g rj ri�V� , � y t. ,, i '� ��� �,�� � aoaz,,;m �v 9 �Y �g�{7L `�3' ir�%LS,,,,,t 'r ��� � i � �� ^�' ; , � � I ' � SLG6 c g �� �sa� sar E , � � � '' � ' �( CO" � � i y�,»� �' � � � � � p � ' � � £ZZZ i��axso�v+rraran t�aiso�v�ni .. , � i > IA � i _..$_ r, ae� ae� cot ,e�.� � s<< «•w � ;Z4 (HEG a) / �esi , 6L.'t) ' � `. � r� r� ^�l£E c 9t£6 I �/ �OE6 i L 8E£9 aE �? � � I iY9qZ ��� (No£'l1 �6) 0£V6 ��l nf - . i,ov}�� L898 �1/_� ` � �zu �, sr.i �t V�J�.% :._ � • . . ., s�?,E<>„.. . . .. �� (vn��>33 . ....... . . ... 6et n,� . ....- .. . .. , � ` .... �_"`* . APPLICANT INFORMATION Account #: 990002389 Billed To: Mark White Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation . Water Supply: On -Site Well Evaluation By: Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5823-54-6481.MW Subdivision Info: Location/Address: Ponderosa Drive -2771028 Property Size: 4 1/2 acres Date Evaluated: d , Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L► Sloe % HORIZON I DEPTH ' Texture groupC L S� Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence l Structure 1 A Mineralogy 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 2 SITE CLASSIFICATION: U6 &,e cle LONG-TERM ACCEPTANCE RATE: r REMARKS: EVALUATION BY: sem' ,C/ OTHER(S) PRESENT: ;--7 eel! 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) ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ OMEN ■E■■ ■■E■ MEMO ■E■■ ■M■■ ■■E■ ■■E■ MEMO MEMO ■M■■ ■■M■ NONE NONE ■■E■ ■■M■ ■E■■ OMEN ■M■■ ■■M■ MEMO ■■■■ OMEN ■ SUMMONS ■■NEEM■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■1EE■■M■Et■■S■ESE■■■■E■■■■■■■■■■■■■t■■MESMM■■■■■E■■■■■■ ■■■■■M■■■■■■■■■ESM■■M■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■M■■■■■■■■■■■■■■■■■■■■■■■■■■■EOM■■■■■■■■■■■■■■■ ■■■M■■■■■■■■■E■■■■■■■M■■■■■■ ■�■■■■■Ott■■■■■■■■■E■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■tea■■■tt■t■■■E■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■E■■■■■E■■■■■■■■■■N■■■■■■■■■■■■MME■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ OMEN ■E■■ ■■E■ MEMO ■E■■ ■M■■ ■■E■ ■■E■ MEMO MEMO ■M■■ ■■M■ NONE NONE ■■E■ ■■M■ ■E■■ OMEN ■M■■ ■■M■ MEMO ■■■■ OMEN ■ SUMMONS ■■NEEM■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ - r � D AVI 4iO NTY-11 _bed 11 D E ENVIRONNIENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #:(336)751-8760_ August 5, 2002 Mark White 4242 NC Highway 801 N Mocksville, NC 27028 Re: Site Evaluation /Ponderosa Road Dear Client(s): As requested, a representative from this office visited the aforementioned site on August 5, 2002. 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, X0 �a vs. 4 � � aA. Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df Enclosure(s)