Loading...
1900 Cana Rd (2) - DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street �f Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 l OPERATION PERMIT Account #: 990004148 Tax PIN/EH#: 5832-42-9238-SVMH Billed To: Sal D'Amato Subdivision Info: Reference Name: Location/Address: 1900 Cana Road-27= Proposed Facility: Residence Properly Size: 54 Acres ATC Number. 4894 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. CLQ System Type: S.T.Manufacturer.`%' Tank Date 2T Kank Size 1;0 Pump Tank Size $_ fl� Y, B Y Y System Installed : ��� � E.H.Specialist: -Date: j ' SEW t 1 l DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848%210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004148 Tax PIN/EH#: 5832-42-9238-SWMH i Billed To: Sal D'Amato Subdivision Info: Referenlve Name: Location/Address: 1900 Cana Road-27028 Proposed Facility: Residence Property Size: 54 Acres ATC Number: 4894 Site Type: 91 ew ❑Repair OExpansion *'NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental . Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900'Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms_#Bathrooms l #People Basement❑Basement plumbing❑ Non:Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) u ll Ir�y Lot Size "( Gl-Ch Type of Water Supply: ❑County/City ell Community Well pV System Specifications: Design Wastewater Flow(GPD) uU Tank Size / GAL.Pump Tank. GAL. Trench Width _ Max.Trench Depth t Rock Depth' AY,4-Linear Ft. /33o--P Site Modifications/Conditions/Other: Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the dai of installation. Tele hone#(336)751-8760. too . c,4°tom Environmental Health Specialist //� Date: N'UT) 1110ri(Revked) Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Account #: 990004148 IMPROVEMENT PF &/EH#: 5832-42-9238-SWMH Billed To: Sal D'Amato Subdivision Info: Address: 1900 Cana Road Location/Address: 1900 Cana Road-27028 City: Mocksville Property Size: 54 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: er5Years ❑No Expiration Residential Specifications: #Bedrooms 7-- #Bathrooms 1 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) KAWA&W65g'� Design Flow(GPD): Tye tetet�rinu Nell ❑Community Well accepted Systems may alsobeuss Site Modifications/Pemut Conditions: System Type LTAR Initial 0• 7 Repair . Y Site Plan 1 RJ - �iV Environmental Health Specialist _ -- Date A P�I&A TE EVALUATION/IMPROVEMENT PERMIT& ATC r J�j 18 avie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 ENVIRONMENZAI Hj� (336)751-8760/Fax(336)751-8786 Appli tion For: 0 "' OUN a ion/Improvement Permit ❑ Authorization To.Construct(ATC) @Both Type o cation: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility 'IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed �Aa�(G� Contact Person .5; Billing Address Home Phone City/State/ZIP -C" Business Phone yQd Name ori Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged -� NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name��� , • �, �,m Phone Number --�Q�—l.� Owner's Address_ L�� � / City/State/Zip 2,712 Property Address -AftCity Lot Size Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: /YD O GO/ If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes ❑No Does the site contain jurisdictional wetlands? ❑Yes.VNo Are there any easements or right-of-ways on the site? ❑Yes)(No Is the site subject to approval by another public agency? ❑Yes Wo Will wastewater other than domestic sewage be generated? ❑Yes Wo IF RESIDENCE FILL OUT THE BOX BELOW [# PeopleZ— #Bedrooms ( #Bathrooms ` Garden Tub/Whirlpool Yes 10% ❑Yes JMNo Basement Plumbing: ❑Yes Pfo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:. Kconventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑New Well X(xisting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes X�o If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pennit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie Co ty Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understan at I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or stakin a e/fa 'lity locawellti r o cation and the location of any other amenities. Site Revisit Charge erty owner's or owner's legal re esen tive signature Date(s): �� Client Notification Date: DaX EHS: Sign given ❑Yes ❑No '� ' Account# t`f 0 Revised 11/06 t \`` Invoice# 1 76/j� R N R G 0 . E I UES Ire ��. FSM Rq� - I�.�. • � - ��'�- 80A.Ro a"m ` �C TREE UNE ' • . � sir (_'1—_.'—--� 1` vim,. .. �` • � —`-7".�L' N 82'1531, u �•.rr �� Gt'f'2LZ• . • 861.81 - ' //-- ' • '. , e 4.e`w1ke-1 555 33W I '� "�fl Ctveit, S 77'02 57 E! i� AREA= 2 7. 50 7 A•0'. • -(AREA: INCLUDES S.R. 1411 R/W) •' _ _ ZONED Req i E DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004148 Tax PIN/EH#: 5832-42-9238-SWMH Billed To: Sal D'Amato Subdivision Info: Reference Name: Location/Address: 1900 Cana Road-27028 Proposed Facility:' Residence Property Size: 54 Acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON H 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: EVALUATION BY- LONG-TERM ACCEPTANCE RATE: 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 Moic VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 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 11,2:1,Mixed 1YQtes . 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 Jess Classification=S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gaVday/ft2 DCHD 05/05(Revised)