Loading...
141 FM Steele LnDAVIE COUNTY HEALTH DEPARTMENT pa Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 l� (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002420 Tax PIN/EH #: 5747-13-3153 Billed To: Levon & Royster Norwood Subdivision Info: F -M :S-eQS 4J Reference Name: Location/Address: Off 27028 Proposed Facility: Residence Property Size: .550 acre ATC Number: 3333 **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 HOOScF #People 1& #Bedrooms 14 #Baths 3 Dishwasher: Q" Garbage Disposal: d Washing Machine: GR Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size p. a�� A.�Type Water Supply Design Wastewater Flow (GPD) Site: New 17( Repair ❑ System Specifications: Tank Size I OCO GAL. Pump Tank GAL. Trench Width Rock Depth" Linear Ft.' Other: !.>aT9—k&L)rI0o3 `mac,-�, l'`L�a� u�tS q 'C,> -C- A-, W, Required Site Modifications/Conditions: 11)S i ALI 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.**** I�z � 151 O � Ql.nl�. 201 Environment Health Spec'alist's Signature: DCHD 05/99 (Revised) N'W 5 1 bar, To Y� Aty'c- LVCATIoA 1-\. tl PIS)LIgJTI'-j 8�x3S D- ate: DAVIE COUNTY HEALTH DEPARTMENT P Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002420 Tax PIN/EH #: 5747-13-3153 Billed To: Levon & Royster Norwood Subdivision Info: Reference Name: Location/Address: Off Deadmon Road -27028 Proposed Facility: Residence Property Size: .550 acre ATC Number: 3333 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** 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 WASTEW IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature - Date: 12— 2 V 7 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 I 1 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. /o1 *&Or -'4vt 1�j 2,3 Septic System Installed By: Environmental Health Specialist's SignaturDate: DCHD 05/99 (Revised) r' • , APPLICATION FOR SITE EVALUATI ON/I&IPROVBI ENT PERMIT & AT 11 S�S Davie County Health Department D Enviro=enta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-876.0 8 9,1�'E� ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE, INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructio s.. 1. Name to be Billed n ', n�t� tLUd-d Contact Person r Mailing Address C7J llama Phone / City/Stat©/ZIP ' / Busines-s Pnhone "5(J �/— �36 a iS 2. Name on Permit/ATCQif Different thane Above Mailing Address ,4 G City/State/Zip I Jqdy 3. Application For: ;?Igi a Evaluation 0 Improvement Permit/ATC -*loth 4. System to Service: X House n Mobile Home CI Business ❑ Industry IJ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher 1�Garbage Disposal Washing Machine I_I Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type ' # People # Sinks # Commodes_ )kShowers # Urinals # Water Coolers IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City Cl Well lJ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes >(No Ifyes, what type? ***IMP0R7ANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICA'T'ION. c�_ 5s D Property Dimensions: . WRITE IRECTIONS (from Moch's7vi�tic) to 1 ROI I;R'I'1, Tax Office PIN: # � 5712-/3- 3 I -j- �U Q C'°- -'�!J Property Address: Road Name�� City/Zip iYIOCi 7, If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property, This is to certify that the information provided is correct to the best of my koowlcdg . s t rat 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 ant responsible for all charges incurred from Misapplication. 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 to conduct all testing procedures as necessary to de(ermine the site suitab' DATE g 9 ^ SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (I ude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). �L n-71 0% �� 1002 Revised DCl) r,l 4�La Site Revisit Charge Date(s): Client Notification Date: EHS: tL�4ea' Account No. oma- oro Y�,J � %y Invoice No. DAVIE COUNTY HEALTH DEPARTMENT • - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002420 Tax PIN/EH #: 5747-13-3153 Billed To: Levon & Royster Norwood Subdivision Info: Reference Name: Location/Address: Off Deadmon Road -?702P Proposed Facility: Residence Property Size: .550 acre Date Evaluated: 0 L Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH O - Texture group6- Consistence Consistence Structure (3 C MineralogyHORIZON 1 II DEPTH ' Texture group t Consistence ,r Structure k Mineralo I HORIZON III DEPTH Texture group L Consistence -SN Structure 1 Mineralogy HORIZON IV -DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: 6J S LONG-TERM ACCEPTANCE RATE: REMARKS: Sim Qvc-t_ 'rpt 2� t�F Sol'— LEGEND EVALUATION BY: Jei--C—t-t-I� OTHER(S) PRESENT: 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 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) ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ i ISANO iiiMMMMM iMMENE ■ ■ ■ ■ NEON NONE ■■E■ MEMO MEMO ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■N■■■ ■■■■■■ tx far r i T ,t n/f 1�ngha o North Caroline R8 .x �3„bra r9, 4 P � S 88854#381' lo' _ a� ,�' • ► f Stone Fod77.54►. "-,,,-.--► S 83*28106"E i". F9P 102.41 qr z Tax Lot 3 N Tax wt 4 Tax 81oak A .� Tax Tax, A a +B Tax, Map, -5-8 �o Tax Mop *-5-8 n/f 1,6vart S. Norwooif c n/f John 0. Steele hualsand a and calfs, t3o1r Norv/oad fi Alice .Steele I '404 D8,1Q8 d PG 414 RB 310 0 PG 880 r by computer 0.539 Acres +/— by computer �: �, 0.471 Acres +/— by computer rh , c p w ti w r+ , C' ;' N \h 1y2� /`4y Proposed 30' R/W ? 1o�� / ,apd� per Greene Survey See Note #1 h° Tax Lot 5 , Tax Block A 20 /� Td*` Map K-5-8 1 n/1` Azalea Steele Tax Lot 6 DBY k 108 O PO 409 Tax Block A h 0.495 Acres Tax Map K—b-8 n/f Sylvia B.: Steele N 6y computer G DB 1Q8 Q PG 424 g' iJ 'U, 0.501 Acres kby computer Tax Lot 1 To,: � Tax Block A -� Y r Tax:;Mop 3 r' n/f 060i S. Searles •': Q o DB 108•.+4 P0434 y s t t14* X23"E 0.516 Acres +/-- by computer Total Y xi 4 �k k:••' y v r ' IRS • k f 145.00' FRS N 85'06'58,,W 85.00' IRS 58.53 Cna '08.35' Total F to G onorow � a H (4.83A) O i•tb I _ F; :. (335) 118 180 565 , CP' � «=' 9( A) a 4185 3153 w 2140 GnB2 --------- x 103D �g ° %5936 - � 4954 t*�r . 2828 (1.03A) rl7j9J 0862 _ 408.54 a 33 Q t 26991.0 F NA c „ - x . cv Y 1: ' j --- ---- ----- --� ' 'o 4445 043 1S 5402 i 294 Ln �� n DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336) 751-8760 / Fax: (336) 751-8786 November 19, 2002 Levon and Royster Norwood 4727 Bromley Ave Suitland, MD 20746 Re: Site Evaluation - 0.55 Acre Tract/Hwy 601 S Tax PIN#: 5747-13-3153 Dear Mr. And Mrs. Norwood: As requested, a representative from this office visited the above site on November 19, 2002 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. a champ, R. . Environmental Health Section Enc(s) w1 zz* 0 a