The URL can be used to link to this page

118 East Chinaberry Court Lot 14AUTHORIZATION NO: 0968 DAVIE COUNTY IIEALTH DEPARTMENT v S D AU Environmental Health Section PROPERTY INFORMATION m=ttee P.O. Box 848 er'jD\A��15 Mocksville NC 270 Q1 R28 Subdivision Name: sp (I2. Phone #: 704-634-8760 Directions to property: �Oi $ " tSr.' Section: Lot:4 AUTHORIZATION FOR WASTEWATER Taz Office PIN:#5� SYSTEMCONSTRUCTION. UL4, _ - Road Nam *NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of airy Building Permits. This Form/Authorization Number should be presented to the Davie County Building. Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S::Chapter 130A, Wastewater Systems, Section,1900 Sewage Treatment and. Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.,s , ENVIRONMENTAL HEALTH SPECIALIST,: .DATE ISSUED '. '" `'I_� DAVIE COUNTY HEALTH DEPARTMENT'-�T^G �(1 W A I`�T�- 'L� 1' j j.atWvEMENT AND OPERATION PERMITS PROPERTY3NFORMATION r .R ibti Subdivision Name:64, Ducpo s to property: c{a:%i i .� Crc Section: Lot:_ IMPROVEMENT PERMIT Tax Office PIN•#-M Road Nam Zip. **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. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) , j ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IP SITE, PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED . SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE.LL #BEDROOMS–,— # BATHS �_ # OCCUPANTS 1' GARBAGE DISPOSAL. I es o o` COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFf - # SEATS INDUSTRIAL WASTE: Yes or No - LOT SIZE L'6%TE WATER SUPPLY\ DESIGN WASTEWATER FLOW (GPD) - b� NEWS r REPAIR SITE _ ' . , 1I a�lyp, I 2oD SYSTEM SPECIFICATIONS: TANK SIZE (10 —OGAL PUMP TANK --GAL TRENCH WIDTH ROCK DEPTH laYR LINEAR Fr. y OTHER—t - - REQUIREDSITE MODIFICATIONS/CONDITIONS: - - "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 -130 P.M. ON THE DAY OF INSTALLATION.. TELEPHONE # IS (7041 6348760. AUTIIORIZATTON NO. OPE TION PERMIT BY: DATE: **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 05196 (Revised) - APPLICATION FOR SITE EVALUATIONAMPROVEMENT PI MIT P, ATC� y. Davie County Health Department [ Q` Environmental Health Section �j P.O. Box 848 .IUN — 31997 UI Mocksville, NC 27028 (704) 634-8760.�, t ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS I $ ALt� THE REQUIRED INFORMATION IS PROVIDED. , 1/ I, A 1' p 1. Name to be Billed M i Y e Mit �+- Contact Person i . V KV, L, a ] n Mailing Address 17 t-l�r l P.e a -(c Home Phone 41 o - r ' T3� City/State/Zip the j -o . �a�t n_ IJ C Z) l ( Business Phone q 10 _ 1Z, 2. Name on Permit/ATC if Different than Above n P.\Lsr a Bu 1 dertr i Mailing Address S A" '{ City/State/Zip 3. Application For: ite Evaluation [�J Improvement Permit & ATC [ ] Both 4. System to Serve; -{-Mouse [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms_ # Bathrooms - ZDishwasher [ ] Garbage Disposal I [ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats.—Estimated Water Usage (gallons per day) 7. Type of water supply�unty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? PROPERTY INFORMATION REQUIRED:*** IMPORTANT*** dfflbb"F THE PROPERTY MUST BE SUBMITTED WITH T�II)S APPLICATION. Property Dimensions: oly4a •a-4 t�aay�2 WRITE DIRECTION^�S''(/Ifrona- [�nlocksville) TO PROPERTY- Tax Office PIN: # \5-79/ -8 / x-5-3 Property Address: Road Name lL-t 4� 9 [V N City/Zip %ilOf'IeSV If in Subdivision provide information, as follows: Name: Sot*- r, 10- Section:-2- orSection:2 Lot 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. 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 �A%a Lko con ct all tes in procedures as necessary to determine the site suitability. DATE /C7 SIGNATURE Revised DCHD (06-96) - - THIS AREA MAY 13L USEb FOR bRAWINC7 YOUR SITE FLAN: - C q *-� 270.65' 1 0, x co South Ari O ---272.03p—. r _ p S 03 '00"w, r*i ` 10' Utility Easement `224.96'OD — 1 C73 N 03645'00"E 0 I. –• o cn -U I^ ` _ — 274.98'— I Q ►v L S 03 5'00'V _--_- 22 .90- I _ d S 84°55'45"E ° I 52.0 " I _.a ^ — — 2E .96' Total — 45- c„ 81.96' � rS 03 '45'00"W ( - (� 54 20' ,, „E ` I 100.00' I I S 0546' 35' E – Qtio 00I -- '212.61'' c� f 0 rn I ra -� N ; 10. Utfdify Easement,;,,,-- 151:70' 1 rn S 04° 10'35"W 371.45' Total "' �n Wa/f Wi/s j o Rc rq r x C: _ N O �U n o 0I 1 0 DB 112 i FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 FEB 2 8 1996 1.:Application/Permit Requested By T KgY-e Scoicegood agent { oA MA. /Mu. Rod woodwand 300 South Matn StAeet 704-634-7010 Mailing Address Home Phone MUCKSVILLE, N. C. 27028 Business Phone 704-634-2222 2:.. Name on Permit if. Different than Above 3: Application for: IN General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 2 5. If house, mobile home: SubdivisionSection 3/4 No. of People No. of Bedrooms 3 2 No. of Bathrooms Dwelling Dimensions 73OU sq. Aee-t +- :.6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes D No. of Sinks No. of Urinals /34 --> Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing 91 Washing Machine Q Dishwasher ❑ Garbage Disposal No. of Lavatories A No. of Water Coolers No. of Showers Water Usage Figures 7.. Type of water supply: ® Public ❑ Private 8. Property DimensionsSee attached trap Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑CNo If yes, what type? ❑ Community NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: PROPERTY INFORMATION REQUIRED: Tax Office PIN: # S71%7�f�v PROPERTJ,ADDRESS, as follows: Road Name: South AAbbA city: Mocfzyi. .Ce. N. C. SUBMIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. 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 application. I-ebAuahy 26, 1996 T. Kyte Sw.ceegood,.agent 6 o DATE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ _1. 1 OWN the property. Cir. 2. 1 DO NOT OWN the property.. If you checked Box #2, the rest of this form MUST be completed by the �towner �tohr �aeperson authorized by the owner: I hereby give consent to the authorized represent ee oL� J�,�vise C od' WooWD aartment 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 absor tion sewage treatment and disposal system. T. y g Ce o hebAuahy 26, 1996 — DATE AT E MM (1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation q NAME DATE EVALUATED ADDRESS S � � PROPERTY SIZE MLI X a I PROPOSED FACIELTY lst�0. LOCATION OF SITE Dsi acs Rc� Water Supply: On -Site Well _ Comm it - Public V Evaluation By:CSL— Auger Boring - - Pitr 7 Cut FACTORS 1 2 3 4 Landscape position Slope z - b HORIZON I DEPTH Texture group Consistence Structure Mineralogy LVI 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: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: IN) d N G REMARKS: A 4avA ��1�1w4 d LEGEND'S Landscaoe Position R-RidgeS-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 Moist VFR- Ve.-y friable FR -Friable FI -Finn 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/112 DCHD (01-901