The URL can be used to link to this page

1548 Hwy 801S',..ry.r,..-_-::;+,f rv.,.•i>:fi.v..krar:�v. F�,,.. r .J;r �:4 -:«f � - ,..�, .a .. ..-�. t\'-s,��.. F• r '.? � •i` a fl' r } � .� y:• .r [ .,. ._ - IX6 DAVIE COUNTY HEALTH DEPARTMENT ._ IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **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 B.S. Chapter 130A, Wastewater Systems, Section .1980 Sewage Treatment and Disposal Systems) NAME i 46/7 &r U`I �d4 PROPERTY ADDRESS 7D d (p DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATIONe BUILDING TYPE# BEDROOMS & # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE RC TYPE WATER SUPPLY (G DESIGN WASTEWATER FLOW (GPD) D NEW SITE G REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE ,�� GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT: QA OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. • r IMPROVEMENT:PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:38 A.M. OR 1:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT Eu FV' /Qa I� SYSTEM INSTALLED BY�5 EV jot p G lob AUTHORIZATION N0. O �n 1 WRATInN DFRMTT RY .� �,. � 4 n nATF **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 138A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOFILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION _ Davie County Health Department �.-►— ' .` - ENVIRONMENTAL HEALTH SECTION' s' ' P.O. Box665 R "l Mocksville, N. C:\27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTIQN ' (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) .***This Authorization For Wastewater -System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fore/Authorization Number should be presented to the Davie County Building Inspections Office applying forBuildingPermits.*** whwhen NAME ' DATE, 2&& NO 0 4Nl!7 �•.If//flr�f NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health DepartmentFIR 2 1 a Environmental Health Section l5 L5 V � `� a P.O. Box 848 y.s q Mocksville NC 27028 .L. 2 3 , (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROC NL SE S ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed /I--- /�C�l f0� Contact Person Mailing Address 20!1 acilr Cif! RD. Home Phone City/State/Zip �f��,t ter_ ,U -e: ,2 7,.747 C Business Phone %7��- .5—� 7/ 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Wite Evalua 'onmprovement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People t' _ # Bedrooms 3 # Bathrooms 9` [.J'6ishwasher VGarbage Disposal [Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify # Showers # Urinals # Water Coolers # People #Sinks # Commodes If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [County/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 *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: a uw,. rf .' WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #-SS 'L - 9 S -51,-16 7' J40 ,t,_ c: P< / Property Address: Road Name Y rrliL-r Selt`lt r9.7. IF -9 City/ZipA66n,� t /V -l. �%� ; 9!v %li If in Subdivision provide information, as follows: Cts; /( Jpw t --P;, Gc�O I"P,¢ //0,.,,, Name: Section: 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 DATE 3 - Revised DCHD (06-96) SIGN conduct all testing procedures as necessary to determine the site suitability. 0 09 9L99 (d09' 9) I08 0985 XKNI cczz) NAME ADDRESS PROPOSED FACIILTY DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public LI Evaluation By: Auger Boring 11_� Pit Cut FACTORS 1 2 3 4 Landscape position L L Slope % 41 HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH b+' y - Texture group C'� Consistence Structure •C 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: T LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: OTHER(S) PRESENT: 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 <:lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty 'clay C -Clay CONSISTENCE Moist VFR- Vc.-y 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 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/ft2 ■...■.■.■■.■■■■■....■■......■.■■■■■...■....■.■■..■■.eee...e■■■■e.■ ■■...■.■...■■..■■....■■..■■.......■■....e�■■�..■■■■■..■....■■....■ ■...■........■.■..■■.......■...■Mee■■e.■■■e.ee■.eee ■ee■■ee■■■■.■ ■■.■......■e■■■..e■■eee.■se■■■..■■■■e■e.■eeee..■....�E■■■.■■■■■■■■ ■.■....■e.■■..■..■e■......■C.■e■..■.■.........■■■■■■■■e■■■■■■■■M■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■..■■.■■.■e■■..■.■.■■.e..se.ae■■e.eeee.e■■.s.■IN ■..■.... ■.eeeee■e■ _ _ ■.■■■■■■e MINN...=■■.e..■MNso N ■■■■■e■■■e■■eee■e■■ee.■Me■■e■■eeeee■....■■■.eee.■ ■■■■e■■■■■■■■■E■ ■.■..■....■....■.■■■■..■Ott■■■ee ■■ec■ceeeceEEccceeeeeece■e■■■■■■ ■.eee......■..■■..■■...■......■ ..■■■■.N..■.■........■........■ ■■■a.■■.■.■■.■.■.■ss■■.o...■Ee..■.eeeee■eE.ewes■.■.Eee..eee..ee■■ ■eee...e.e■■eee.■eee■......■■.■■■■■..e.e.eee......�e..eecee.■eOMEN ■■..■c.....■■sec■■....■...■..■...■..�■Hee. ...■.■ ■■■■■O■■■..M■■I ■■...■■.......e■..............■.e■ ■ ■■eee■ MM■Me■■■■■■ ■ ■eee■ ■■...■ecce..e.eeee■e■ceM..c■eeee.e�c■e��e■eeeM.e■e.�eec■.�■ENEM�■ i0iiiii■ioiiiii0iiiiiiiii::iiiio�®iMEMOIN e�®oi="MMMMMMIiiiiiii�i®i ■■.ee......e■.sae....N.■.■sE....seM.■..■..Ms ..■.. ■....■■.s.E isiiiiiiuiiiiiiiiiiiiiiiiiiiviii�ii:a�'�®ii:iii�=e�.'�ii'u'ieiiii®i■i isiiiiiiiiiiiiioiiiiioiiiiiiiiiiiiiiii��I�iiiiii■�iiiiiii=iiia®®®i iiaiiiiiiiiiiiiiiiiiii■is�iiiiii�mo®gym®i�.ii"'iiiii�.i iiii®®®i ■..■M■.■c......N■..■.ee■ee...ee.e..■■■■■■■■E ■M■NME.■■Eee■■ ■■..■...■■...E.■.....■■..■■e....e■.ee■■ ■■■■.■.e....i...■i.■.i...■■i■.t.i■.e.i■.ee�..■■...■i....i■...i....i...■i....i.M..�.■....■.i....i.e..i■.M.i.■■.i..M.i.e.�.eM..e■".■■...e.�.■■■"..e.N■■.'�...■H.■"." i■■�■■■'■.'r.. �■NMM.M■�M.mom ■■ ■ INN mom 19 .■ ■■■.M■■■M■■■■■■■ _ ME Ii ' mom i" MENEMi =. = mmm ■ ■ ■ ■ e MMMMAWEMMMMMM . ■.....■........■..■...■..._■�■M..■■.e■ .. EEe.eeee■eee .....■.■.■..N.....■E.■■e.e.Mee■.e..e ■E�ME■.■■.■ ................■...■...■■.■■..._._■■. ■ NINE M::�:: ■..........NH..■...■....M.ON■ . u■ ■..M.■■■EE■.u......■■ OEM OEM ■..■■.■.....■.■.....■■...■.■■... . ■ ■■.■N■■ MEMO ■■....■■■■..N.N.NN■ ■e. ... .■ ■ ■■.e ■■■ NONE ■.■■■....=.■.ee..u..e. iee.=■■■ ON ON ■M■■■.11MMMMMMMRIM No No MENNEN SOME 0 MEN ON MOMMEME �■ ■Mee■ee..eeeE...■...■eeec■c■.MEMO ■■ ■ H■e.ee■ ■.......■.... M■. ■..■■.ecce..■ ■ I1■■■■■e■■M■■ ■ec.eM.....E�■ER■M■M■■EEM■M■■ R{■■■MN■E■■ ■MEEMMMMIN ■■■■■. . ::::" ::': ..................................... I Io Mm 0 M99FW MMMEMM■M ■.■■...■e■■.■■..■■■cM.........■MI■■ ■ ■ IM. .■E■■■■■.■No. ME NEM � ■■ fY�''� ' ■ �iiii'iEiiNiii ■■M■.■ ■■NEEM■■■ ■■.■■■C■/M■Ilwo■■ ■� ■ Mea_ �oHml■�■M■.■.■■■ ■■.■■■ ■M.►■\■■■a�MC.■/ \■l�ilis�.... .I.�.•��i1i.�i.:::�::M�.■■■■■■■■■ M.■■■ Melts..\MM■\M ■ ■■.■■.■.■...■■MN...■....■.■.... N........■■..IMMMMIUMMEM■■■■...■ MEii=iiiiiiiiiiiiiiiiiiiiii■aiii''I'■ieii�iisiiii�iiir'�iiiiiiiiiiii=i Davie L'ounfy Nealffr rDe arimenf and .glome YleaM Ayency 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 July 26, 1996 t RBH/wd Enclosure(s) Sin erely, Robert B. Hall, Jr., R.S. Environmental Health Section Re: Site.Evaluation i NC 801 South Tax PIN: #5870-95-5676 Dear Mr. Patton: i As requested, a representative from this office visited the aforementioned site on July 25, 1996. Based upon 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. If you have any questions, please feel free to contact this office. ,R i y- t t RBH/wd Enclosure(s) Sin erely, Robert B. Hall, Jr., R.S. Environmental Health Section