Loading...
2029 or 3737 Hwy 801S DAVIE COUNTY HEALTH DEPARTMENT ►r �+ IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT'`U **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 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME lel PROPERTY ADDRESS �� r�a 1 S Z 7 a®Cn DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE _ # PEOPLE/SHIFT Atj# SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE , =GAL. PUMP TANK SAL. TRENCH WIDTH ROCK DEPTH ,�//a? LINEAR FT. a 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. ©•J c��11Z Ac 44 h� IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY lDop�� AUTHORIZATION NO. q OPERATION PERMIT BY _ DATE Alp **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 13OA, SECTION .1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FlMCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 �j Davie County Health Department ENVIRONMENTAL HEALTH SECTIQN 17 P.0,8n 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authd'rization For Wastewater System Construction oust be issued by the Day-le County Environmental Health Section prior to issuance of any Building Permits. This Fors/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** AUTHORIZATION MYM*R NAME 0 3 LS DATE NAME ON IMPROVE]ENT PERMIT (If different than above) SITE LOCATION 412 Al�' COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE*** THIS AUTHORIZATION FOR WAS SYSTEM CONSTRUCTION IS VALID FOR A PERIOD.GF FIVE (5) YEARS. ENVIRONMENTAL HEALTH SPEC IJ AUST DCHD 10/95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS a Davie County Health Department (� WIE Environmental Health Section U P. O. Box 665 0 1996 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address `a/ /��t?/p �T �� Home Phone- ZeZ4JCC22CD4��_Business Phone 2. Name on Permit if Different than Above � 41 3. Application for: ❑General Evaluation IQ06ptic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly VBusiness ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # l/ Basement/Plumbing No. of People ? ❑ Basement/No Plumbing No. of Bedrooms �� ®'Washing Machine No. of Bathrooms ishwasher Dwelling Dimensions arbage Disposal 6. If business, industry, place of public ass ly, other: Specify type AP-e,_ �/ No. of People Served No. of Sinks No. of Commodes 6 No. of Urinals No. of Lavatories 3 No. of Water Coolers No. of Showers c, Water Usage Figures 7. Type of water supply: ❑ Public L?I rivate ❑ Community 8. Property Dimensions IM 141-1111Sewage Disposal Contractor 9. Do you anticipate additions/expansion of th5 facility this sytem is intended.to serve? es ❑ No If yes, what type? , 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. 9y-?raid PROPERTY INFORMATION REQUIRED:�Ezz _87 e9.aa) Directions to Property: 00/ .Od Tax Off i ce PIN: # /�� /�_ , • �� PROPERTY ADDRESS, as follows: Road Name: /�� S City: /7,5�1J 191'yCl � 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. -C2 DATE SIGNA URE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY F;and ECK ONE: 1.x'1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. ��� DATE SIGNATURE DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation i NAME ��Q //T" DATE EVALUATED s ADDRESS PROPERTY SIZE i PROPOSED FACIILTY LOCATION OF SITE/ ® � Water Supply: On-Site Well �/ _ Community Public_ ` Evaluation By: Auger Boring i Pit Cut_ FACTORS 1 2 3 4 Landscape position J_ Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure h Mineralogy ,'/ 1. HORIZON III DEPTH Texture group Consistence Structure Mineralogy i HORIZON IV DEPTH Texture group j ' Consistence t Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Footslope 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 "ICL-Silty ;lay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V{..cy 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 MineralojZy 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(01-901 ■...■....■.moms./■■....■..■.■.■■■MM.BM..■ ■OM■MEMMMMEMEM■ ■.■.moms ■■■■..■■M■MM=■■M.M■■M.■M■■M..■■■Mmo.nE■■ EM■■■M■■==E■■■■■■■■■■■■■M ■■■■■■■■■■■■ ■■■■■■■■■■■■m■■■■■■ ■■M.EMME■MEEMEos O.■■■E■■M■■M■■■ ONE MOEN NM......■■■.■■.■■■..■....■..■.■.■■.■.■MEMMMIC- ■.MlNONE.�MM■.MME■■O■ ■...■.■....■■.■■■.■■.■■■■■..e■.■..■M.MMM■MME■■■.■■...■.■■■■■■■..■. ...........■.........■..........■■..■.....■. ■M No.MME■E..OSMMEEM■■ ■....■■■E.■E.■M■a.M....■■■■■E■■n■■■■■■E■EMM�..mo■ ■..■■■.■.■■■■ N ■■■■■■■■■■■■■.O■■..■■■M■.■....■■.■.�...■ ■ ■.■■�■■■■■■■■■■■■■ ■.■■■■■..■..■■.■■..■.■.■■■.■■■.■■■■■ ■■■■■■■■■�■ ■■� ■s■sO■NWOMEN ■■■■■■.....■.M.MMM.E■.o.M■o.E■■MUMM■■mom IMEM moms■ ■.mom.■■�MENEM ■■.■■.......■...■......■... ■.■■ ■�■EM.�0 M■■o■■E■ ■EEMUMMEMMORM MEN ■■ ■..■...■.■■■■■..M.■E■E.oM..■■■M■mo■■■■■EE■■�■Es ■ ■■ N� ME.■O■■ ■■...■.■■.M■■■ME■E■M■■■■■.■E■■■.�■■MEMO■H ■■I i■i ■E ■■■■E■■■■■■■mo■■■.■....■.■■�.■.■ ■.. .■ Ms ■..........■..■■.■...■■■■/.mo■■.■ ■■..■n■n���e:e■■mon■■■■ ■NMENEM ■■■■■■ MEMMINI OEM ■■■■■..■■■.■■.■■■■■■EMEMEME■■.M■■MAV■■■■i �eN.■ .■E■u■NE.■■■om ffinmm"I ENO 0 ONE ■.e■■■■■■■■■■■■■■■.■■■E■E■■■■■.■.po ■ H E=.moms■■ .■..■_■.■.■■mo■� ■■■mo■■■■■ ■E■■E■mo■■M■mo■■■■.■■■E■� !f ■■E■■ ■ sN =■■■■ ■ ■moms■ ■.■■.. :Amoss.N■■■.ss■N■■E■■■Esis�M■E■.■.MEN ■� ,...�� ■■.■E■■Ho.�E■■./1i■■���'■O\:aim - QZiBmuu E■■■oE■.M■M.■■..■/=■ME ■.....sE.■■■■.■....■■■u■O.■■.■■0■H■N■M■=■M moms./...EH■MEMO MMMMMMMMMMMI:::::: :::C :: .':�:::::C ".:: SON .■■■■■■.■■■.■s■■■E■■E■MEEMME.■Ems■E■EsssSON Nss ■ �s■�■■O■E� ■■.■■■■■■s..■■■■■.■■■.■.■■■■■..■■■■■.■■■i■.... .�. .� moms■■■ ...■■u■MMES■Omo1■■O■■.■O■ss■.■MMO■MEM■�■ .■..■� u .■■.� uMEMMM ■EMME■O■EME■mom ■oommE.■EMEMEM. MN .�■HH ■HN.■. ■MME ■■.mo■M■/ ■MMMMM■MMEmoms .■/■MM■ ■.MME■ moms■H. ■En .H. ■O ■■O■ME. OMEN MMEME ONE ■EMOTE.■........■..E■■■■■■E■E■.H ■H■ . ...�...No ..� OMEEo■■■M.EE■..■■ E■M ■■moms■■ ■■ MEN MEMO M■■EE■Eo . ... MEMO. No ME M■MEMS . eo ME■EE Mme.. ■.oE■. Ir1■ON■■ moms E■n .� N�E'■■■■s .�■H■ ■■ MH ■ ■M.MM■■■ MEMO 00 on No MEN��'�H"�O�■'��.��■HOS ■�� .■M�M�MM OE■MOM�o H�H HH ■ _NS oil OMEN EMMIUM MEN MONO MEN M ONE OMEN SEEM ■■■0 MEMEMNEEM.EEH■M. .H ■ ■ ■ H■■M■ ■■■.SOME■mo■.■ ■ s. ■■sE■Es■ ■0 ON NEWS! =■nEO■No o ■■MM■M■H � 'n'iNiiiii��' ■..H�vNi MENNEN WON ...■■....■.�mommom No MEMO ..EC. . .n ..... ..ME■EOE■O■.E■■■■ONE ON M■.E■.■oM.E■■H . .■.0 ■Ei menMEMO ............................... .■'�iC= iiieiiu■. ■E■/ ■■■■■E■ ■H■.■ ■.■■■mo H moME ■ �M■H.n ONES 0 M ONE ME mom....... ...... NEW ME WORSE MEN .... .ONE........■■..�.■..■■■.....SOMME ......... ........................■OEM........■EM.M■mom E.■.M.■NEMESES■ME■■E■ ■■.E■M■E.■E..■■■M■O■■MEMO EE=EOSE.■EMEE■.E■HE■■ ■ME■EMEM■O■■■■■.mm moms MM■MM■M■■■EE■M■■MEMEEM EEEEe.■■MM ■M■.Ho�■■E■HMmoEMOMNM■ ■