Loading...
188 Graywood Court Lot 14' DAVIE COUNTY HEALTH DEPARTMENT I Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-38-2199.14DB Subdivision Info: Redland Place Lot # 14 Location/Address: Graywood Court -27006 Property Size: see map ATC Number: 3674 **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 Ulm( #People 1 #Bedrooms `4 #Baths Z' J Dishwasher: u Garbage Disposal: ❑ Washing Machine: e Basement w/Plumbing: 0"" Basement/No Plumbing: ❑ Commercial Specification: Facility Type n ,#,PJeople #People/Shift ##Seats IndustC3trriaal Waste: Lot Siz 7 2 AZ Type Water SupplyW l%� I -I Design Wastewater Flow (GPD) `TOO Site: New 12 Repair ❑ rl n r System Specifications: Tank Size I �OGAL. Pump Tank GAL. Trench Width Rock Depth 2 Linear Ft. 4� Other: Ll � 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 Count/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.**** G o• Q2 nvironmental Health Specialist's Signature: e: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Billed To: Darren Burke Constr. mce Name: ed Facility: Residence ATC Number: 3674 Tax PIN/EH #: 5861-38-2199.14DB Subdivision Info: Redland Place Lot # 14 Location/Address: Graywood Court -27006 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION VOTE** 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 CON ON IS VALID FOR A PERIOD OF FIVE YEARS. vironmental 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, ection .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY betaken as a guarantee that t system will function satisfactorily for any given period of time. V DSK f, G�nJ 1 11� Septic System Installed By: Environmental Health Specialist's Signature: 05/99 (Revised) I `0 A`0 5861 l3 3969 Ethel S. Cook D. B. 64, p9 186 S88'43 1 04 284.84, (LI9 3 S Ft. Acr s± 83003'57" E 418.9 0' 16 60, 95 Sq. Ft. 3 1 Acres± 26.1To-..too� --__ N8 VI, ma e .100 J7� ; 199 14 `'' l �r 34,067 Sq. Ft.• 1 782 Acres± 30,1 0.6� r� 4 v Radius �s°\a,G• 50.00 ry • dGs �J g- 41- 3� _ CB-- ,�`�, 17 O' 33,771 Sq. F 0.775 Acres± 3U �_51,39� -��- --•� ieb-03 04 08:50a Darren Burke 336-778-0436 V jun 10 03 11: 14a day i e county envheea l th dye /D l toloo r.. c p. 4 • APIUjMIGN FOR SITE EVALt1ATWN/tW11OVt71MT I'fJ1h1fT .V AIC Davie Catinty Health Department P.o. 8mt a0a/210 Hospital st1-aac Nocksville, NC 27028 1336)7S1-8760 y rs.XIVORTANT**• ii XS JlP11=0CION CANNOT HE PROCBSSEV U=SS AM TIM REQUIRED __f 1 INFORMATION IS PRoySDEA. Refertothe AiJF_ORMAT20N HULLS?YN for iDStructioao. 1. $a. to he skilled ���e/t. T7:� Contact: Person q.ilia9 addnea `igj SiD /,lFsrh _ fidgeed Thune �'7lrr6tt tecit,/Sta/ZIT NG?+� ,�s'em�e 1. lfw eh.>toslt/ATC St Oltterent than Above xaslley Add:.,. eicr/scala/zip _.. ...._ __ 1. Application For: Ito -ralnatioa Cl Zaprovoment rermit/ATC ❑ Both s, srwcca to se>vie.:)dT�Fttoy�yuaa ❑ Mobile Hama ❑ Business 0 Xndustry ❑ other S. Type systtn regvee([ watiaul ❑ conventional soditled ❑ Innovative 6. It Roaidence: s People '-f 0 Bedrooms 0 Dathrooms olehvasher CfWrbwge Oispn.alehing Machine /fYDaseoef�tfP� SagL ❑aasenent/Ke >Lwhing ! 7. Ir 8ueieh:eue e/Iadtry /Other: verity type a ►mple o Simko I Co!.Madta 0 :afereto / urlawla a ester Caalera IS FODDMMVICRI d Soatn Rat -4 --ted Hater Usage foallooe par dayl _- a. Type of star aopplyKIG ti ty/City ❑ Wall 0 Coe®unity, Y. aw yon anticipate aaaitions or expansions of the i7atity this Systcnn Is intended to 3.•crve7 Q YCs el mu tf yrs, taut type? •-ihfPORTANP•`* C ors MOST COMPLEIETHE mauIRED PttOrLICI-y tHP'ORMATIOtt ItLQUtm ria) BELOW. Matra -Pt AT or SIM PLAN JULCrDESt/BBrMTED by The dknt vikkk THIS APPLICATION. Property Dimensions: ! `i K 3L1 C, /)Tx ) $ / wtuTE D1ttEC1'Ioris 4am hloeksvulC) ICPltt n' ^ /� Tar erre 1411. a,�� l - 3 � "-2 IT 7. I `i / � D Property Address: Rwd N211de 'ter) C t� Citymp 6 AZ IR L' £d trill a Subdivision provi Wforo , as follows. Stenon: II1oek: Lot. Date home corners 02CC sl: This is to certify that Uuinfotsnabon provided is correct to the best of my knor►kdge. 1 uaderstaad that any perulil(s) issued hereafter arc subject to stapension or revocation, If the site plans or intended mo chaaM or If the information sutm+used w ibk appliculan is faWrord or chnoget 1. r[so, a rlrrXoiullbar / am rcs/wnsi4lrjor all durrga' /nCurred jr�ru+ this oppliozidwL 1. hereby, give consent to file Authorilmd Representative of the Davie County ucallh Uepa imml �' { to enter upon above described property loafed in Davie County and owned by �prt1 = �jtJt to conduct all testing procedures as uecessary to determine We site suitability DATE SIGNATURE THIS AREA MAY HE USED FOR DRAWING YOUR Sr= PLAN (,Include At of the follonine: Existing and proposed property lines and dlmcesions, structures, setbacks, and septic locations). Site Rcrisil Charge Datc(s): Client Notih WO01i Data EII5- Sign given Account No. Revised DCHD (85/03 Invoice No- ,—�—� / / APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 DEC 3 zo2 fN�/RAN �\�E�NI�C HfAlru ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed e V Contact Person of / Mailing Address m Ea Home Phone �A City/State/ZIP bd -sE , 271p Business Phone 22 a 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: p -Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: -use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher LI Garbage Disposal LI Washing Machine Basement/Plumbing fl 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) 7. Type of water supply: R-County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? EHYes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETIiE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: G, 57 A -C"(- 'S Tax Office PIN: # 59 ;3�-,-2/97-/ Property Address: Road Name ZZI/, / City/Zip WRITE DIRECTIONS (from M/ ocksv`illlle) to PROPERTY: � IZEZ '4-1 t o L� /, e.4 If in a Subdivision provide informatio , as follows: Name: :�� A- — r5w MAP Section: Block: Lot:�o L P -r JgDate Property Flagged: Ir;? ---3-- 1!9 L— 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. 1, 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 _,& O �4 �►%,d ft/ 5 to conduct all testing procedures as necessary to determine the site suits ility. DATE 3 a� SIGNATURE, 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) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.16 Subdivision Info: Louise Smith Adams Lot # 16 Location/Address: Redland Road -27006 see map Date Evaluated: Z a� Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L_ Slope % HORIZON I DEPTH -ioO Texture group CL Consistence Structure Mineralogyl- ►� ) HORIZON II DEPTH Texture group G Consistence Structure Mineralogyaf's HORIZON III DEPTHTexture rou / Consistence Structure 592)4 - Mineralogy 1"l HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE L SITE CLASSIFICATION: V5 LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscaae Position EVALUATION BY: ��'Jtl%G►"`� OTHER(S) PRESENT: 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)