The URL can be used to link to this page

1904 Sheffield Rd � Y DAVIE COUNTY HEALTH DEPARTMENT �}F IM(PROVEMENT PERMIT and OPERATION PERMIT Id.8 IMPROVEMENT PERMIT 1 R **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. �V (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME �i / PROPERTY ADDRESS -S�--ITIE' �d— /�� . DATE LOCATI i Irl SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTRL SPECIFICATION: BUILDING TYPE �A # BEDROOMS oQ # BATHS # OCCUPANTS ,� GARBAGE DISPOSAL: Yesd. COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) L�O NEW SITE � REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE Zj2j7Q GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT..pft OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **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)634-8760. OPERATION PERMIT SYSTEM INSTALLED BY �� C�,ttiyvyt, E( Ott t r q. AUTHORIZATION NO. C.CJ�'�S OPERATION PERMIT BY J`/GLL( DATE -fQI-' **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 10/95 :.. VX D s= Davie County Health Department ENVIRONMENTAL HEALTH SECTION '= y_ P.D. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to issuance° n�ding Permits. s Form/Authorization Number should be presented to the Davie County Building Inspections Offi cr when applying for Building Per its.*** NAME DATE _ /��o76��s � AUTFiDRIZATION'HUMBER 2 0045 NAME ON IMPROVBW PERMIT �(If �different than abovee))A ,p 3' SITE LOCATION �/Jr�Y/G -Al-err 7�0.9,y t<, , ✓e COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ***NOTICE*** THIS AUTHORIZATION FDR 5TEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. �J • /6�G��S� ENVIRON EKAL HEALTH SPECIALIST DATE;; DCHD 10/95 � . . 1 i ON FO EVALUATION/IMPROVEMENTS PE MIT ounty Health Department I it mental Health Section / P. O. Box 665 J Mocksville, NC 27028 1. Application/Permit Req y Mailing Address Z Home Phone 74 /-`4/ s a a 7 Business Phone 2. Name on Permit if Different than Above 3. Application for: a General Evaluation l7Septic Tank Installation Permit 4. System to Serve: ❑ House "obile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms O-Washing Machine No. of Bathrooms ��" ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ublic ❑ Private ❑ Community 8. Property Dimensions /21Ael - Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: _e �� io �T s � � I �t This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this ap lication. d � e5s- - 4m;:Z� DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Lel MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation / NAME o'er DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE � � y��' Water Supply: On-Site Well Community Public L� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope r HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH L Texture group Consistence i Structure >�� Mineralogyf l 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: EVALUATED 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 :lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vc.-y 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 .3C--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(01-901 ■■■.■.■■■.■..■.■...e.■.■■/.■....�..■..E■■■■ ■e■.■■■■■E....E■■NEON ■■......■.......■..■■..........■...■....■.■epi■■■■■■.■■■■■■.■MENNEN ■..■■.■■■■■■.■■■.....■.■.■....■..■.■/■.E.■E■■■■E■e■.■■■■■E■■■■■won .....■..................................■..�.....■..-■.■..■■...■.■ ..............................................■..■._ OOE■■.■.EOE.■ ................................ .E■O■■■■■■■■ONE e■■■■E■E■E■E■O■E■ ..................e■E■.■■.■■..........._......._.■.._■■■■■..■.■■■■ ........................... ........... ....... ..■■ ■■■E■ENO■ONE■ ■■■■■.■■■.■■■■■.■.■■■.■■■■■■.■■■■■.■■.■■ ■■■ ■ ■■■ ■.■E■■N■ ■■ ■■■■■■.■■sE■E■■.■■e■■■■■EE.■■■■■■■■■■E■.■■■eE■■■■ ■■■■■■■.■■.■■..■ ■.■.■.■■■■■■■■■■■■■■■■..■■NOON■ ■■E■■■■■■■■■e■■■E■■■■■■■■O■■■■■■ ■...■■■■■■■■■■■■■■■■■■■■■E■■■■■■■.■■■O■■■■.■■■■ME No ■■■■■■■■■■■■■ ■■■■■■.■■■■■■■■■■■e■E■■■E■■EE■E■■■■■■.■■■■■■■■. ■ MEMEMEMMOMM■■■■■ ■■■■■■■.■■.■.■■■■Ee..■■.■■.■■■...■■■�H.■■�■.■■■■ ■■■■■�.■■NONE H .� ■■■■■■■■■■■.■■.■■■■■■■■■e■■■■■■■■■ ■ NOON■■ ■■■ ■■.■■■■ ■ NOON■ ■■■■■■■■■■■■■■.■■■■■■E■■E■■■■■■■E■�i■■E■■■■E■■n■■■ ■ ■■■■■Em momma ................................�//..■.■H�■ .N■N........■■ ■■N ................................ .HOME■E■ ■■ HEOMEN- mom ....■■.....� ■■.■■.■■■■■■■■■■■■.■..uN■.■■...E.■E.O■.■■■e■E■■ ■■ .■■ ■O■■■■ '_ :": ::::IC .........................................�.....�C� ■■■:�■.I::::� ■...■H■■.■■■..■..■.■■■■■■■■■■■■■■■■■.H. .NOON■■ ■M■■■.No 92 = EME ME MOM mom monsommo HOSOMEM META .ii.■.i■i■.ii