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127 Irishman Place Lot 19I1; /18 •1 J►Y_y- .19: YO 1 9'; : YuID►YI Environmental Health Section � P. O. Boz 848/210 Hospital Street MockrAlle, NC 27028 . (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M. 990002073Tax PIN/EH #: 5789-73-7450 Billed To: Norman Building Subdivision Info: Shamrock Acres Lot # 19 Reference Name: Location/Address: Irishman Place -27006 Proposed Facility: Residence Property Size: see map ATC Ndmbec 3029 **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 I I 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 140019 1E #People I #Bedrooms 3 #Baths 2. S Dishwasher: Garbage Disposal: ❑ Washing Machine: O'�' Basement w/Plumbing: El'�_ Basement/No Plumbing: El Commercial Lot Size ©: System Spec Required Sit Facility Type #People Type Water Supply CDO T Design Wastewater Flc ations: Tank Size IWO GAL. Pump Tank GAL. Trench Other: 3 'lDt5T21(2St)TtCQ G oX 4odifications/Conditions: lJ%TaLJ- 0,0 CO MOt/2. t' #Seats Industrial Waste: ❑ (GPD) 3 OO Site: New Repair ❑ idth 3(a'U Rock Depth 17 - Linear Ft. i IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 w 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.**** Health Specialist's DCHD 05/991 (Revised) ��JG hF ,up S G \�� 1�1�.9ES t•J /IDALF.""r-_ JG1C: rS82l �- t 2000�' Cox'A W'3T3lt�a�'sX„x I t n 3 - $D' x 5U'>e 1 1 &-glsa•> 4-7 02 t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002073 Tax PIN/EH #: 5789-73-7450 Billed To: Norman Building Subdivision Info: Shamrock Acres Lot # 19 Reference Name:. Location/Address: Irishman Place -27006 Proposed Facility: Residence Property Size: see map ATC Number. 3029 **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 Ai icle l l 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 TypeOQQ:EF,' #People #Bedrooms #Baths 2•.j Dishwasher: Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: e Basement/No Plumbing: ❑ Commercial specification: Facility Type//++ #People #People/Shift #Seats IndustriaEll Waste: Lot Size Qr i1 AQ4uS Type Water SuppI42n) Y Design Wastewater Flow (GPD) CW Site: New 0alRepair ❑ System Specifications: Tank Size 1000 GAL. Pump Tank IW JAL. Trench Width ` Rock Depth 12 Linear Ft. zco Other: 3 �1�j r2lB,�loJ F � GaSTAU, LIAES 9ro•C. l�t,,�•. Required Site Modifications/Conditions: � t swj, DJ C -V -j )r- V U�15� p`F 06JSr t o orF PSP tA-19 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.**** NtN.rd— o V -g N(hc,j u•1Fi irJ Vt,�,pM � 5gSTv -- yy' )N LOW Environmental Health Specialist's Signa e: DCHD 05/99 Reference ATC L> DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 (� 'k, it* 990002073 Tax PIN/EH #: 5789-73-7450 1 To: Norman Building Subdivision Info: Shamrock Acres Lot # 19 tme: Location/Address: Irishman Place -27006 fiber: 3029 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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 he Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of J.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS 4UTHORIZATION FOR WASTEWAISI ST CT IS V LID FOR A PERIOD OF FIVE YEARS. tal Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit ias 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 functionsatisfactorily for any riven period of time. p` '�o �t i3r/ CB+.1T�1C�v2/ iJtl i C9h1 �Eitt •� s L;r�TE1s - - 100' Z. J*IV Septic System Installed By: Environmefital Health Specialist's Signature: DCHD 05/99 (Revised) i4 . rP• 412,Z - t/ APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERNUT & Al D V lei �p Davie County Health Department V t EnvironmentaiHealth Section D P.O. Box 848/210 Hospital Street DEC 7 Z00% -Mocksville,INC .27028 - (336) 751-8760 147,?o M DAVXP lM, RFAJ ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQU - INFORMATION IS PROVIDED. -Refer to the.INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person Mailing Address Z/, Home'Phone City/State/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address - 'City/State/Zip 3. Application For: ❑ Site Evaluation, rovement Permit/ATC ❑ Both 4. system to service: 419 duse _ ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # PeopleC Bedrooms # Bathrooms ? 'AL . -f 'ahwasher ❑ Garbage Disposal A'w sling Machine' 4"Base—m—eennnt/P�lumbing - LI Basement/No Plumbing 6. If Business/Industry/Other: specify type #People #Sinks -- # Commodes # Showers _ # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) yA• 7. Type ofwater supply: -County/City i ❑ Well - ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Luzwi If yes, what type? ***IMPORTdNT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM/TTED by the client with THIS APPLICATION. Property Dimensions: pp�� //;; —7'1 I' WRITE DIRECTIONS (from Mo4cksville) to PR8606&e4 OPEIVIN: Tax Office PIN: # 7YJ"1 7 3 I (%�S/� (Pq �D ( (N T 2 86 6 &e4 Property Address: Road Name r 1 TIL, D ubt l�� �� U` �✓ I rW� vt . city/zipy(dla�Z.� z7at)r0 �I�l•� F+ If in a Subdivision provide information, as follows: i - Name: '5AAINkd'0LA— Cg -6 J Section: —14---q-' Block: 0 Pplot: Date Property Flagged: I z 6'1- 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 arc 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 INS 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 suitabi ity. DATE IZ` c�'6I SIGNATURE - "O I 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). Revised DCHD (07/99) Account No. -),b / Invoice No. I �j2-.A� NAME DAVIE COUNTY HEALTH DEPARTMENT'! Environmental Health Section Soil/Site Evaluation DATE EVALUATED ADDRESS K Awa PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE %G2g� I Water Supply: - On -Site Well Community Public Evaluation By: Auger Boring Pit- Cut FACTORS 1 2 3 14 Landscape position .G Slope % �a HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence i Structure >L l Mineralogy 2-7 HORIZON III DEPTH Texture group Consistence Structure t Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE z SITE CLASSIFICATION: PI LONG-TERM ACCEPTANCE RATE: REMARKS: - DCHD(01-901 I 14`/ EVALUATED BY: 1 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 •.lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR-Ve.-y friable FR -Friable FI -Finn VFI-Very firm EFI-Extremely fine 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 SBK-Subangular blocky PL -Platy PR -P 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 inc with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unst LTAR - Long-term acceptance rate - gal/day/f(2 ABK-Angular blocky from land surface to soil colors