Loading...
335 Aubrey Merrell Rd DAVIE COUNTY HEALTH DEPARTMENT ���/,/S'fJJ�f • ;= �' ' Environmental Health Section z.� P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)75]-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990000791 Tax PIN/EH#: 576&54-3551 Billed To: Brad Queen Subdivision Info: ��3� Reference Name: Brad Queen Location/Address: Aubrey Merrell Road 27028 Proposed Facility: Residence Property Size: 3.3 Acres ATC Number: 2204 **NOTE** This ImprovemendOperation Petmit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 f�' #People� #Bedrooms� #Baths� Dishwasher: � Garbage Disposal: 0 Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size �y�c Type Water Supply�� Design Wastewater Flow(GPD)_��� Site: New�Repair❑ System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Width���Rock Depth���Linear Ft. d 6� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FINiSHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Departrnent for final inspection ofthis 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.**** � � Environmental Health Specialist's Signature: � G��// � Date: �/2 �"/ DCHD OS/99(Revised) , , w DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000791 Tax PIN/EH#: 576&50-3551 Billed To: Brad Queen Subdivision Info: Reference Name: Brad Queen Location/Address: Aubrey Merrell Road-27028 Proposed Facility: Residence Property Size: 3.3 Ac�es ATC Number. 2204 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his 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 WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � _ Date: /���//�C � CERTIFICATE OF �:C ,��IP E I N , **NOTE** T'he issuance ofthis Certificate ofCompletion shall ii icat;;�the s st escribed on ImprovemendOperation Permit has been installed in compliance with Article 11 of 6. Cha' ter 30 , ection.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken a� :;ua:,ntee h th system will function satisfactorily for any given period of time. ' , .� i�;i �'� _Q K J�u \ V� k l � � t 5 � ' �i�� �1,��� t�s L���;� , ���,�5 �� l�Js���� � �a m , , ,`4, �"•JC�ur�' (��'�cri' I—��� ��.� , Cr4 a� �s � • o�c�o2�sA-) (-2cr,J 7 Septic System Installed By: ' 1 � .� Environmental Health Specialist's Signature: ate: . �DCHD OS/99(Revised) ANNul�a�lUN Da le C unty H alth Deparbnent p�MR&ATC D [� [� [� � �] � :,. s .' � Envi►ronmenta/He�a/th Secrdon p.0. 8ox 8�8/230 Hoapital Stra�t S�P 2 7 �� . Mockaville� NC 27028 � • (336)751-8760 � Et�VIRONP,1EPaTAL NEAl.TH p;1VIE,CQU�aTY ***Si�ORTANT*** THIS APBLICATION GNNOT S� PROC�88aD VNI.E88 ALL TH� REQUIRaD __ iNFORMAT=ON t8 PRGVZDED. Rafer to the iNH'ORt91TI0N BULLETZN !or iustruatioaa. ' i. M.e. to n. s�ll.a �fl�J (�U��'dV cont.�ot r�r.on '� �jUt�fV M.s�s� �... �l 07 �w�l (t�LIF ao�. �. �33b— �'t9S-`77r�/ ct�/et.t./s:p mn�.�,�5 U�� , �7C o17o�k au.s�... ��. 70�! -�5y - �01�f Z. lfaa� oa �rait/7►2C i! Di!l�ru�t tl�an 11bov� lfailiaQ 71ddr��• City/8!a!�/EiP . a. 1►pp].iastioa gor: 0 Sita $valuatioa (] Improvem�at p�rmit/71TC �Soth 4. sY.t.� to e.r.io.t I�Honso 0 Mobile Home ❑ Hnsitt�sa ❑ =ndtistsy ❑ Oth�r �ArYO s. i� nesidano�: f geople � f Hedrooms �� � 8athrooms � 9�i�hx�sls�r ❑ carbaq� Dispo�al �Kashiaq ltaabin� 0 8aiwnt/plw�biaq 0 Eas�nl./l�o pltmbinq 6. I! Swia���/Indu�try/Oth�rt Bp�oilY tYP� � �oPi� # Siaka � Commod�� � Shox�rr � Uriaal� � 1rat�s Cool�r� =S a'OODSERVZCE: # Seata 8stimat�d 1Pat�r Usaq� to•ll�. � a.�r� �. Typ� o! �rater suppiy: �Couaty/City 0 1��11 0 Communitp e. Do yoa anticipate addlHons or e:panelons of the faclltty t61a syatem ia intended to aerve? 0 Yes 0 No If Yea,what type? . ""*IMPORTAN7'�'**CLIENTS MAST C�OMPLETE THE REQilIRED PROPERTY INFORMATlON REQUEBTED BELOW. Either a P1.AT or S1TE PLAN MUST BESUBMITTED by the client wfth TH13 APPIICATION. Property Dimeuslons: .3 - WRITE DIRECI10N3(from Makaville)to PROPERTY: �'lfo��3�",�f� �KC Tai Ofllce PIN: # J^7 D no D o o tiq ����r�sT _ A�uT �To(o �nz��� a«� Property Addreu: Rosd Name Flu�l� �F,ie�l.�_�lD, o F nr.x,ks,r�cr -T,�aKr ��if�an /✓�ft0�L1 S � Clty/Zip �oG�S�S:ZZ�,61C, �� �+��C 2Q Ant� TH-EN 7AK� G�'Fro s✓ If in a Sabdivtsion prvvide informaHon,as follow�: Ru f��E1! ►�►'aP_77�,CECL e� ', f Cc p�eT1/�-s Name: -�Bo�T �lc�o..1�s -�o ��b1�fT 3n1 +4�3�'L Q SecHoa: Block: Lot: Dute Property FI�gQeds q' a��'�1C1 This is to cerNfy that the informallon provided is correct to the best of my knmrledge. I anderatend th�t�ny permit(s) Isaned hereatter are sabJect to saspenaton or revocadon,if the eite plana or tntended ase c6enge,or if the InformaHon sabmitted in t6ia applicaHoa L�faL�ttied or chenged. t,also,ande�tand tbat 1 om nspottslble jor a!I cbargea/ncrrrrcd from tbls app/1caBon. I,hereby,give eonsent to t6e Aathortzed Represenbtive of the Davie Camty Had Ikpa�ent to enter npon Above deacribed prnperty Iocated in Dsvte Coanty aad mvned by� P. R�A(1(�l.►�L'n/ to coudact all testing procednres aa necessarp to deternilne the ette snibbWty. DATE I '�� - 1�( SIGNATURE ���u�e,e.�-� THI3 AREA MAY BE USED FOR DRAWING YOUR S1TE PLAN(Inclnde all of t6e follmving: EziaHng and proposed property Ilnes�nd dtmen�tons, stractarea, eetbacka, �nd aepdc locadons� Stte Rcvistt C6arge Dste{a)s � Cllent NotiScutton Date: EHS: +'� . Accoant Na / Revised DCHD(07/99) Invo[ce Na G'� �- • ,�, �� l �.-�-- .. � .. . � - � f � , �, ..���=-�---; %��-- --�.-._�� - � �J "�__ ' 11� ti h � t' _�— �J-,.�/]�1"L— _ ' f� -- � ��'-�' �� �-=—�� ----.___ .. .--—- - .�-�—�_i,�!� - r , � �n,.� r �=_ M�n''� L j�. � ,r;,' ��-�-`�{J�-� —��=—�� � _-1`-._�_____�_, `. -- — � 4 '`-- ��:L �' --` - _ I � �i�_L; �'G cl !.�%�' \ / � � �- , . - - � � � . �� ' � � . `\� . �' r r �� ` i � r4 � /V opa �G ,-, ` . � ..... � „ � e , �i � � , ✓� '�� � �f •. �� � � r .,� � , � � . , ���� � , ��_� �� 1 � �, ,, �Sl�� , � . `�� , �- '�' �, ��,, �,/ �;� � e ,� �,.� , ;� �5 . ��f '+ � / �. f/ � �' � ,'� � �-- _- . , ��� .� � ,. / � , , ,� �, � �. I -� � - � � =- ia � �_� � �:� � � � � , $ � � ,—�y, �_�.� .�':` r' _/• i \\ � / � i�, � /�� �^.S� �, ' . •� /r n s ` r � /) / . \ \\ � �+�/� v( ��" �.. . �� � , � � ` � � ._���, ;� �� '' 1.• TA� ~ � ��, , � � �4 � , %;�j' �Q.��G�STf,Q�o���1 �' % ` r L453 y' �.� ,/ �. � � cr 7�' -.� O ,�O ��o y0 SUR�IE ',� �d o ' �ly CAR�L��P � � C ; '- v, . . . :� � � ; . :— ���� "� �' ' DAVIE COUNTY HEALTH DEPART'MENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000791 Tax PIN/EH#: 5768-50-3551 Billed To: Brad Queen Subdivision Info: Reference Name: Brad Queen Location/Address: Aubrey Merrell Road 27028 Proposed Facility: Residence Property Size: 3.3 Acres Date Evaluated: /��` /$���� -� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo % HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �� ,�(� ' Texture rou Consistence � . Structure b ' S/ Mineralo -/ � HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION - LONG-TERM ACCEPTANCE RATE � � SITE CLASSIFICATION: U''� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: � y 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 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 Mineraloev 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 DC�-ID OS/99(Revised) ■����■��■���■�■��■����■�■■���■■��■■���������■�■��\■■����■���■��■�■ ■■��■�■■����■■���■��■����■�����■■��■�■��■■�����■■��■����■������■�■ ■����■�■�����■■■���■■��■��■�■■�■�■■■■���■���■�■■��■■■��■����■��■■ ■��■■���■■������■�■���■■�������■ ■��■������■��■��■■■■■�■���■■��■■ ■■����■����■��!■■O■���������■■��■��■■���■■��■������■0■■�■�■�■�■�■■ ■��■���■■��■�■��■��■���■���■■��■���■■■���■���■�■■�■�����■■\■■��■�■ ■■■�����■�■�����■�������■■■■��■�■��■■�■�■■����■■■O■�■0�■■�■����■�■ ■�■���■��■■����■������■��■��■����■�■■�■��■■�■��■e�■��■�■■�������■■ ■���■������■��■■�■������■■■���■�■■���■����■■■�����■���■�■�■���■��■ ■���■■■■��■�■■■■�■�■��■�■■�o�■��■��a����■■�■���■veo�������■���■��■ ■������■��■�■����■��■�■■�■��■������■�■��■�����■■�■■�■�■���������■ ■�������■■■�■�■■�■����■��■�����■ ■■■�■t�■���■■■■�■�������������■■ ■��■�■t���■■���■������■■�■���■■■■■����■��■■■����■�■■�■�■�����■■■■■ ■■���■��■��■■■���■�■■�������■e�■��■�■��■■■■��■��■��■��■���■�■■�■■■ ■�■�������■�����■�■�■■■■■��■��■����■■■■■�■��■���■��■�■■�■��t�■���■ ■��■��■■�■���■��■��■��■■■��■��■■■�■■�■�■��■���■�■�■■■w�������■���■ ■�■�■����■��■■�■■■�■�■t�■��■�■�■■�■����■��■�■�■�■��■��■���■��■���■ ■■■�■��■■■■���■����■■■■■■��■��■■■�■■�■�■■��■�■e�■■��■■■■��■■�■■■�■ ■�■��■■��■■���■■�■�■�■■■■�����■■�■��■■■■�■■�■��■��■■�■■���■�■■■�■ ■■�■��������■�■��■�■�■■�■������■ ■■�■�■■�■��■��■��■�����■�������■ ■■��■�■����������■��■���■��■�■�■��■■�■�■■��■�■�����■���■�����■�■■■ ■��■■�■■���■�■��������■����■�■�����■■■��■��■■■��■��■�������■�■��■■ ■■�■■■■■■■�■�■��■�■■��■��■������■■�■■�■�■■�■��■�■■�■■��■■■■■�����■ ■■�����■■■�■����■�■���■■�■��■■■�■■��■■■�����■�■������������■���■�■ ■��■■�■■�■����■�■���������■�■■■��■��■■■��■�■■�■��■■�■�■■����■����■ ■�■■�■�■�■■���■�■�■���■■■�■��■■���■�■■■�■■��■■■��■■�■■■■��������■■ ■�■��■����■���■■■�■■■■■■■�����■■�■�■�■■�■��■�■���■��■■■��■�■���■■ ■�■��■����■�■�■■���■�■■■■�■��■�■ ■�■�■■�■����■��■■��■�■�■■■����■■ ■�����■�������■■■■�■■■■■■����■�■�■■�■�■■�■■�■��■��■�����■■■����■■■ ■���■�■■�■�����■�■�■■■��■\'iL���■������■■���■■��■�■�■��■■■■■������■ ■�■����■��■■���■�■�■■■■�■�r■���■■■■�■■■■�■��■�■■■�■�����■■■■���■■■ ■■�■■���■��■���■�■��■■■�■��■■��■■�■■�■�■■■■��■�■■�■■■�■�■■�■■���■■ ■��■��■����■�■�■����■■■�■�������■�■■�■�■■�■■�■�����■�����■�■�■�■■■ ■�■■�■������■■��■�■■■�■■�����■■��■�■■■��■��■■■■��■■�■■�■������■■�■ ■��■�■��■■���■��■������■�■��■■■����■�■�■■�■■■���■■�■■■■■����■■��■ ■■���■����■���■■■�■■■��■�■■���■■ ■■■�■�■■�■■�■��■■�■■■■������■��■ ■���■�■��■■����■■�■■■��■����■■■�■■�■■�■��■�■■�■��■���■■�����■■■■�■ ■■�■■�■■������■�■��■■��■�■�������■��■�!�1■�■■�■�■■■��■■������■�■■■ ■■�■��■■■�■�■■■e��■■■�■■�■�/!��iii���■■��■��■■■��■■��■■������■■��■ ■■��■��■�■■��■��■�■■���■G�����■��■��■■■��■■�■�■������■■���■������■ ■���■�■■■�■�����■�■■�■■■��■�■�■��■��■■■■��■�■■■■����������■■��■■�■ ■��■��■■��■��■��■�■■■■�■■,�■�■■■��������������■�■��■��■����■■■■■■■■ �■���■■�■������■■■■■■��■��■■■�■�■�■■��■����■�■■��■��■������ ■�■■��■■��■��■����■■�■�■�I�■■�■�■■�■��■■■�I�■��■�■��■■��■�■��■��■■■■ ■��■■�■■��■�������■■�■��/I�■■���■�■■���■■�I�■��■�■■�■���■■■■��■■��■■ ■��■����������■����■�■���i������■■�■■�■■■���■��■��■�■■��■�■■■■�����s ■��■���■■�■■��■�■■�■�■������■■■��■�■■�■�■■t��■�■■�■��■■�������■t■�■■ ■■��■��■��■■■�■�e��■�■�■n��■�■�■���■��■..n�■■���■���■���������■■�■ ■�■■■■�■���■���■■■�■�■�����==::::::�����■■�■■�■��■■��■■■�■������■■ ■�■■���■���■■�■■■■������■��■■■■�����������■��■��■■�■■■■��■■���■■■ ■■■��■��■■�■�■�■����■����e��■��■ ■■■����■�■■�■■�■■�■■■■�■�������■ ■■����■■���■�■�■��o������■■�■■■�■■�■■���■■�■�����■■�■■■■�����■■■�■ ■�■�■■��■��■�■�■�■ve■�■��■��■�■����■■����■��■��■��■��■■■�■�������■ ■■��■■■■■■�■�■N����■�■■■■■�■■���■����������■�����������■■■■�■■�■■ ■�■�■■■■■■�■�■������■�■■�■��■���►����■■■��■■■�■�■■�■���■�■�■■■■���■ ■�■��■�������■�■■�■�■��■�■■�■�■��,���■�■��■�t�■�■■��■������■■■■■■�■ ■����■�■�■�■�■�■����■��■�■����■�ui���■����■���■��■��■������■�■����■ ■■■�■�■��■���■����■�■■���■��■�■��■�■�■�t■■��■��■�■■������■■■■■■�■ ■■��■�■■�■�■�■�■��■�■��■�■��■�■■ ■�■�■��������■��■�����■■■■■■���■ ■�■����������■■■■�■�■��■�■����■��■■���■■�■�����■��������■■■■■■■�■■ ■��������■■�■�■�■�■�■��■��������■■■��■■��■���■�����■��■�■■■�■■■�■■ ■�■■■�■■■■■�■�■�■�����������■����■■��■■��■�t�■��■��■�������■■�■�■■ ■�������t�■���■�■�■■■��■�■����■��■■t��■��■��■■��■������������■���■ ■��■■��■■■■�■���■������������■■■■■■��■■■�■�■■���������������■■■��■ ■■�■��■■�����■��■��■��t���■��■■■■■■■■■�■��■■■■�����■■�■■���■■����■ ■���■■����■�������■■�������■���■ ■����■�■■■■■��■��■■■■�����■■���■ ■���������■�■■�����■�■■�■��■�■■■�i■��■�■��■��■■■■��■■■�■��t������■ ■■��■�■■�■■■■■■�■��■�■■■��■■�■����■����■��■■�■��■��■���■������■��■ ■��■■�■■■■■■■■�■■■■■�■��■�■■���■■�■■�■■■��■■�������■■��■��■�■■■■�■ ■����������■■■�����■�■��■■�■■■�■■�■■■■■■■■■■■��■����■■�■�■■■■■■��■ ■�■■��■■■�■■■■�■■�■■�■■■■■■■�■■■■�■■■��■�■■■�■��■���■■■■�■■������■ ■�■��������■����■■�■�■�■■��■�■�■■�■■�■■■��■�■■��■��■■�■■■�■��■■■�■ ■�■��■�■�■�■■■�■■■�■�■��■■�■�■�■■■���■■�■�■���■■■������������■���■ ■�■�■■�■�■�■��■■�■�■��■■■■■■■■■��■■�■�■■�■��■���■��■��■■■�������■ ■■■■■�■■■■■■��■■�■■■�■■���■��■■■ ■�■■■■��■■���■�■��■���■■���■���■ ������������������■■����■��■����■■�■��������■������■■■�■�������■■■ ■■■■■■■����■��■■�■��■■����■■�■��■■■■�■■�■t������t���■��■�������■�■ ■�■�■■�■■�����������������t■����■■�■����■���■�������■����■�����■�■ ■�■■■��■���■��■■■■■��■■■■■■■■■��■��■�■■�■■�������■��■�����■■■�■■�■ ■■■��■��■■�■�����■■������■�■�■�■■��■■■■■■■�■��■�■���■��■��■���■■■■ ■■■�■�■■�■■���■■■����■■■■�■��■��■�■■■��■■■■■■�����■■■��■■■�■■■■��■ ■■■��■�■���■���■�■■����������■■■ ■�■���■���■���■���■����■■■■■■�■■ ■�■■�■�■■����■�■�■��■��■�■��■■■■�i�■■■■■■�■■��■■��■■����■�■��■��■■ ■�■■�■■■������■■������■■■■■■����■■■■���■�■■■�����■■■��■�■■������■■