The URL can be used to link to this page

165 Turkeyfoot Rd (4). DAVIE COUNTY HEALTH DEPARTMENT 1 Environmental Health Section P. O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002090 Tax PIN/EH #: 5801-21-5621 Billed To: Pallet One of NC, Inc. Subdivision Info: Reference Name: Location/Address: Turkeyfoot Road -27028 Proposed Facility: Industry Property Size: see map ATC Number: 3042 **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 W )` @4 �#Pel plec',2- 41 #People/Shift _� #Seats Industrial Waste: ❑ Lot Size Type Water Supply &//// Design Wastewater Flow (GPD) 0 Site: New 0' Repair ❑ �� l� System Specifications: Tank Size GAL. Pump Tank GAL. Trench Widt /u Rock Depth Linear Ft. 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.**** �: rte. � L ✓ Environmental Health Specialist's Signature _/ Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990002090 Billed To: Pallet One of NC, Inc. Reference Name: Proposed Facility: Industry ATC Number: 3042 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5801-21-5621 Subdivision Info: Location/Address: Turkeyfoot Road -27028 Property Size: see map 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, ction .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAE. 10 RU TION IS VALI 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 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 p f time. t� r 4F 6a� Septic System Installed By:101, xx Environmental Health Specialist's Signature: �(� Date: ZO !/U DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 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 PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �C��(�-�-t� , Q -F NSC -Inc. Mailing Address \V95-C(.IYI�-t Q% 'S�(�Q(�• City/State/ZIP MocXe-,"ime/ 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation 4. System to Service: ❑ House ❑ Mobile Home 5. If Residence: # People Contact Person��i Home Phone Business Phone (33 lQ> L4 q a- 55 l o 5 exa. 312. City/State/Zip ❑ Improvement Permit/ATC ❑ Business VIndustry ❑ Other # Bedrooms # Bathrooms Both I Dishwasher ❑ Garbage Disposal LI Washing Machine ❑ Basement/Plumbing f_I Basement/No Plumbing 6. If Business/Industry/Other: Specify typepa ei momsbuor # People 2 4 # Sinks 3 # Commodes r _ # Showers 46 ' # Urinals ' # Water Coolers IF FOODSERVICE: # Seats 7. Type of water supply: Estimated Water Usage (gallons per day) 0 County/City 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes QKo ***IMPORTANT*** CLIENTS MUST COMPLETETHE -REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PI ANMUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: see Mac) Tax Office PIN: # Property Address: Road Name —Tu'(•he %(3�- City/Zip MCCI-X'--m'MP 49-�O (U If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: �r� 1OWNER i ■ ' Date Property Flagged: lZ --?L— o i 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 falsifiedor 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 ' IZ 71-01 SIGNATURE �i�.eQi� 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: EHS: Account No.y o Revised DCHD (07/99) Invoice No. (3.25A) o. (487) ; 8443 SHEFFIELD CALAHAN RURITAN CLUB H (4.47A) 8638 SHEFFIELD CAL* VOL F. D. cR 1315 DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002090 Billed To: Pallet One of NC, Inc. Reference Name: Proposed Facility: Industry Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5801-21-5621 Subdivision Info: Location/Address: Turkeyfoot Road -27028 see map Date Evaluated: /- Zo - 0, Community Evaluation By: Auger Boring_ b_- Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 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 SITE CLASSIFICATION: 1/< LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: 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) ■ ■ i ■ ■ ■ ■EE■E■■M■OE■E■■■■■ ■EE■■ENE■■t■OS■O■E■ ■■■■OSO■NO■■E■■EEN■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■O■■ONS■ ■OSEE■EESEE■■■O■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■mums SOMME■■■■E■■■■E■ mumu■N■■N■■■■■N■■■■■■■■■■■ ■SES■■S■E■■■■E■SO■■E■■■SS■ ■m■■■■s■■■E■■s■■sus■ms■■Nw ■■■■E■■ ■■■■E■: ■ ■ ■ mumu■ ■■■■■■■■■■■■■■■��■■■■■ NOOSE ■■■E■■■■■O■■■■■11■■E■■ mumu■■E■■■■■■N■■■N■■t■■■EON■ ■■ENO■E■ ■OSEENN■ ■O■SEN■■ ■E■O■■E■ ■■■NESS■ ■E■■EE■■ ■O■■E■E■ ■E■■■E■■ ■OO■OOO■ ■■EEO■■■ ■EEE■O■■